{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:23:22Z","timestamp":1779359002926,"version":"3.51.4"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T00:00:00Z","timestamp":1543708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004348","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010223","name":"Stiftelsen Jubileumsklinikens Forskningsfond mot Cancer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010223","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and aims<\/jats:title><jats:p>Detection of early cholangiocarcinoma (CCA) in primary sclerosing cholangitis (PSC) is challenging. The aim of this study was to evaluate the diagnostic accuracy of a stepwise approach to biliary brush cytology with sequential use of fluorescence in\u2010situ hybridization (FISH) for the detection of biliary malignancy in PSC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We retrospectively studied consecutive patients with PSC who underwent biliary brushings at Karolinska University Hospital between 2009 and 2015 (n\u00a0=\u00a0208). Brush samples were categorized as benign, equivocal (atypical or suspicious) and malignant. Equivocal cases were further analysed with FISH. Samples with a malignant cytology or positive FISH were considered positive. The diagnosis was determined after 12\u00a0months of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The diagnosis CCA was confirmed in 15 patients (7%), high\u2010grade dysplasia in three patients, and low\u2010grade dysplasia in five patients at follow\u2010up. Using the diagnostic algorithm, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for a diagnosis of CCA were 80% (95%CI 52%\u201096%), 96% (95%CI 92%\u201098%), 60% (95%CI 36%\u201081%) and 98% (95% CI 95%\u2010100%). In patients with equivocal cytology (n\u00a0=\u00a061), the sensitivity for CCA diagnosis increased to 100% (95%CI 72%\u2010100%) with a lower PPV of 58% (95%CI 34%\u201078%). The diagnostic accuracy for detection of CCA in all patients was 95% (95%CI 91%\u201097%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Biliary brush cytology with sequential use of FISH in equivocal cases seems to be a highly predictive diagnostic test for CCA in PSC. These results support the use of FISH when cytology is equivocal for detection of biliary malignancy in PSC.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14007","type":"journal-article","created":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T05:31:03Z","timestamp":1543815063000},"page":"382-388","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Diagnostic performance of a stepwise cytological algorithm for biliary malignancy in primary sclerosing cholangitis"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-248X","authenticated-orcid":false,"given":"Erik","family":"von Seth","sequence":"first","affiliation":[{"name":"Division of Hepatology Department of Upper GI Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge (MedH) Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena","family":"Ouchterlony","sequence":"additional","affiliation":[{"name":"Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge (MedH) Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katalin","family":"Dobra","sequence":"additional","affiliation":[{"name":"Division of Pathology, Department of Laboratory Medicine (LabMed) Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders","family":"Hjerpe","sequence":"additional","affiliation":[{"name":"Division of Pathology, Department of Laboratory Medicine (LabMed) Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Urban","family":"Arnelo","sequence":"additional","affiliation":[{"name":"Division of Hepatology Department of Upper GI Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Division of Surgery, Department of CLINTEC Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Haas","sequence":"additional","affiliation":[{"name":"Division of Hepatology Department of Upper GI Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge (MedH) Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Bergquist","sequence":"additional","affiliation":[{"name":"Division of Hepatology Department of Upper GI Diseases Karolinska University Hospital Stockholm Sweden"},{"name":"Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge (MedH) Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,12,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.07.022"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.02.038"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26565"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2015.08.014"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-107029"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2013.09.015"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2014-202731"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2006.08.021"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2013.11.001"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21331"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01776.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22441"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.272"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2014.433"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2016.1263681"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23277"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2009.04.009"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2006.09.004"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181bc96f9"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.14007","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T20:12:39Z","timestamp":1694722359000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.14007"}},"subtitle":[],"editor":[{"given":"Espen","family":"Melum","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2018,12,2]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1111\/liv.14007"],"URL":"https:\/\/doi.org\/10.1111\/liv.14007","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,2]]},"assertion":[{"value":"2018-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}