gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Use of Cell Image Analysis in the Detection of Cancer from Specimens obtained duringERC in PSC patients for screening in order to schedule patients at high risk for liver transplantation

Meeting Abstract

  • corresponding author presenting/speaker Maximilian Schmeding - Charité Universitätsmedizin, Berlin, Deutschland
  • M: Schmeding - Charité Universitätsmedizin, Berlin
  • H. Al-Abadi - Charité Universitätsmedizin, Berlin
  • H. Abou-Rebyeh - Charité Universitätsmedizin, Berlin
  • W. Veltzke-Schlieker - Charité Universitätsmedizin, Berlin
  • Z. Al-Kahlili - Charité Universitätsmedizin, Berlin
  • A. Dürr - Charité Universitätsmedizin, Berlin
  • R. Neuhaus - Charité Universitätsmedizin, Berlin
  • T. Berg - Charité Universitätsmedizin, Berlin
  • S. Jonas - Charité Universitätsmedizin, Berlin
  • T. Rösch - Charité Universitätsmedizin, Berlin
  • P. Neuhaus - Charité Universitätsmedizin, Berlin

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO187

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Schmeding et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Primary Sclerosing Cholangitis (PSC) is a biliary destructive disease with increased riskof developing Cholangiocarcinoma. Today, liver transplantation is the only curative therapy. However, PSC patients at high risk should be accurately selected for transplantation. In an attempt to establish prognostic factors for this selection we investigated the value of quantitative DNA ploidy analysis.

Material and Methods: This prospective study included 120 patients afflicted from PSC investigated within a period of five years (9/98 -1/04). In all patients, biliary specimens were obtained by ERC- guided brush cytology. In case of dysplasia, DNA ploidy was analyzed by image cytometry. Follow up periods ranged from 9 to 72 month. Survival was calculated by using the Kaplan-Meier algorithm. Risk factors were identified in a Cox-regressions analysis.

Results: 5% (6/120 ) of the PSC patients had CCC, primary sclerosing cholangitis was distinguished from cholangiocarcinoma (p < 0.001). The DNA analysis of these patients showed DNA distributions typical for aneuploid tumors. These patients were excluded from transplantation and died within 4 –17 month due to tumor progression. The further 95% of patients revealed different degrees of dysplasia in the brush biopsies. 26 (22%) had benigne, 39 (33%) reactive, 49 (41%) dysplastic bile duct epithelium.27 out of these 49 patients (55%)showed dysplasia with aneuploid DNA distribution. These patientsunderwent either transplantation (n=24) or liver resection (n=3). 5 /24 of these patients died within 17-34 month after OLT. and 3/3 of patients died withhin13,21,27 month after liver resection. 45% (22/49) revealed dysplastic cells with tetraploid DNA distribution. Thereof, 11 patients were liver grafted and are so far in good condition. 65 out of 120 patients (54%) showed biliary cells with a normal euploid DNA pattern. Therefore, these patients were followed up clinically and by ERC with brush cytology and DNA cytometry. The sensitivity of assessment of ERC derived specimen by means of DNA ploidy in our study was 97% and the specificity 100% in distinguishing between normal and malignant disease .

Conclusion: Quantitative DNA-analysis in PSC patients performed on ERC guided brush cytology specimens of biliary duct epithelium is a successful screening approach to identify patients at a high risk for CC development. These patients require either intensified follow up investigations or early liver transplantation.