ABSTRACT
The diagnosis of cholangiocarcinoma in PSC can be challenging. Imaging techniques such as CT, MR, and positron emission tomography have proven largely unreliable in distinguishing benign from malignant biliary strictures. The majority (approximately 80%) of CCAs in PSC occur at the liver hilum, corresponding with the most frequent location for dominant strictures in this disease. Brushings and/or biopsies for cytology taken at the time of ERC have only up to 43% sensitivity in detecting malignancy ( 11 ). Recently, advanced cytologic techniques that identify chromosomal abnormalities including digital image analysis (DIA) and fluorescence in situ hybridization (FISH) have shown promise, but further study is warranted before widespread application is possible ( 12 ).
