Biliary dysplasia as a marker of cholangiocarcinoma in primary sclerosing cholangitis

Background/Aims: Indentification of biliary dysplasia in a primary sclerosi ng cholangitis (PSC) liver biopsy may indicate developing cholangiocarcinom a. The objectives were to determine whether biliary dysplasia can be recogn ised reproducibly in PSC and to compare the frequency in cases with and wit hout cholangiocarcinoma. Methods: Liver biopsies from 26 PSC cases with concurrent or subsequent cho langiocarcinoma (within 2 years) were assessed for biliary dysplasia indepe ndently by three liver pathologists, This was done in two stages: initially , without agreement on criteria, and subsequently after such agreement. Liv er biopsies from 60 PSC cases without cholangiocarcinoma were also assessed . Results: Reproducibility for biliary dysplasia without prior agreement on c riteria was only marginally better than random (kappa=0.129). In contrast, after prior agreement on criteria, reproducibility was moderate (kappa=0.44 ), Billary dysplasia was agreed to be present by all three pathologists in 23% and 19% of biopsies In the first and second round, respectively, from p atients with cholangiocarcinoma, but in none of the patients without cholan giocarcinoma. Conclusion: Criteria for biliary dysplasia can be agreed and the entity rec ognised in liver biopsies. The strong association of biliary dysplasia with cholangiocarcinoma in PSC suggests use of dysplasia as a marker for curren t or developing malignancy. (C) 2001 European Association for the Study of the Liver. Published by Else vier Science B.V, All rights reserved.