Histological Analysis of Liver Biopsies in Primary Sclerosing Cholangitis and Comparison to Primary Biliary Cirrhosis: Identification of New Biliary Lesions Useful for Sclerosing Cholangitis Diagnosis and Scoring Proposal
M-T Paoletti, P-Y Boelle, C Corpechot, O Chazouilleres, D Wendum. APHP, Hôpital StAntoine, Paris, France
Background: The diagnostic bile duct lesion of primary sclerosing cholangitis (PSC) associates periductal fibrosis, atrophy of bile cells and sometimes replacement of the duct by a fibrous scar. However, these lesions are infrequent on biopsies and the distinction between PSC and primary biliary cirrhosis (PBC) on histological appearance may be difficult. We analyzed several lesions in PSC and PBC in order to specify the lesions observed in PSC and to find the most useful criteria for the pathological diagnosis of PSC.
Design: 59 liver PSC and 71 PBC biopsies were studied. Patients with cirrhosis or associated auto-immune hepatitis were excluded. The following lesions were assessed in each portal tract : periductal fibrosis, biliary cell vacuolization, biliary cell atrophy, bile duct stenosis,bile duct irregularity, floating cells in the bile duct lumen, cholangitis. Activity, fibrosis, ductopenia and granulomas were also assessed on each biopsy. A statistical analysis was performed (Student's-t or Fisher's exact test, logistic regression).
Results: The PSC and PBC biopsies were comparable according to the length or fibrosis stage. Compared to PBC, PSC biopsies showed more often periductal fibrosis (p<0.0001), biliary cell atrophy (p<0.0001), irregular bile duct lumen (p=0.0005), floating cells (p=0.001), stenosis (p=0.002) and biliary cell vacuolization (p=0.02). PSC biopsies showed less often ductopenia (p=0.0003), activity (p<0.0001) and granulomas (p<0.0001). Only 21 biopsies showed the typical lesions with both periductal fibrosis and cell atrophy. Moreover, for each bile duct analyzed individually, there was no correlation between the presence of concentric fibrosis and cell atrophy. On the contrary there was an association between concentric fibrosis and an irregular lumen (p<0.0001), the presence of floating cells (p<0.0001) or cell vacuolization (p=0.02). Finally a score was build to discriminate PSC from PBC. ROC curves showed an area under the curve of 0.93, and a specificity of 97% and sensitivity of 77% for PSC diagnosis if the score was >6.
Conclusions: We found some new biliary lesions associated with concentric bile duct fibrosis and with PSC diagnosis. We also build a scoring system that could be useful to discriminate PSC from PBC on a liver biopsy.
Category: Liver & Pancreas
Monday, March 22, 2010 1:00 PM
Poster Session II # 187, Monday Afternoon