system for percutaneous nephnostomies. Radiology. 1982; 144:174. 5. Clayman. RV, Castaneda-Zuniga. WR, Hunt- en DW, Lange. PH, Amplatz. K. Rapid bal-.
References 1.
2.
3.
4.
5.
6.
Castaneda-Zuniga WR, Clayman R, Smith A. Rusnak BM, Herrera M, Amplatz K. Nephrostolithotomy: percutaneous techniques for urinary calculus removal. AJR 1982; 139:721-726. Hare WSC, McOmish D. Nephnostomy lavage set for dissolving renal stones. Radiology 1982; 144:932. Bush WH, Crane RE, Brannen GE. Steerable loop snare for percutaneous retrieval of renal calix calculi. AIR 1984; 142367-368. Rusnak B, Castaneda-Zuniga W, Kotula F, Herrera M, Amplatz K. Improved dilator system for percutaneous nephnostomies. Radiology 1982; 144:174. Clayman RV, Castaneda-Zuniga WR, Hunten DW, Lange PH, Amplatz K. Rapid balloon dilatation of the nephrostomy track for nephrostolithotomy. Radiology 1983; 147:884-885. Ricketts HJ, Rudd TG, Marcus VL, Knieger JN. Pneumopyelography: an adjunct to percutaneous nephnostomy and nephnolithotomy. AJR 1984; 143:1093-1095.
ing the initial diagnosis of sclenosing cholangitis in which the cholangiographic appearance is often indistinguishable from cholangiocancinoma. In their series, the histologic diagnosis was obtained by duct biopsy either at lapamotomy on at autopsy. However, biopsy of the bile ducts at surgery fails to detect this
disease
Primary
Sclerosing Cholangitis: Cholangiographic Appearances From:
Alan B. Lumsden, M.D. Jonathan P. Alspaugh, M.D. Departments of Surgery and Radiology Emory
University
Hospital
1364 Clifton Road, Atlanta, CA 30322
N.E.
Editor: We read with interest the article entitIed “Cholangiocancinoma Complicating Primary Sclerosing Cholangitis: Cholangiographic Appearances” by MacCarty et al. (1), and we congratulate them on an excellent
review
of a difficult
subject.
De-
spite identifying marked duct dilatation, progressive duct dilatation, and prognessive stricture formation as indicators of cholangiocarcinoma, they concede that none of these features is specific for malignancy; hence, some doubt usually pensists.
A similar
dilemma
also
occurs
a
Radiology
of cases reliable. treatment
and, of
sclenosing cholangitis at our institution is nonopenative management. The initial diagnosis is largely based on the cholangiographic appearance obtained during eithem percutaneous transhepatic cholangiognaphy on endoscopic retrograde cholangiopancreatography. When possible, treatment with percutaneous cholangioplasty
and
long-term
stenting
is pen-
formed. We have some concern, themefore, that cholangiocancinoma could be misdiagnosed either during the initial diagnosis of sclemosing cholangitis or duning follow-up of a true-positive case of cholangitis
where
often.
We
suggest
that
bile
MacCarty
We
and
and
would
like
Alspaugh
cemning ma
our
for their article
complicating
The
trend
erative liver
colleagues
to thank on
comments
institution
management
until
transplantation
Lumsden
con-
cholangiocancino-
sclenosing
at our
respond:
Drs.
cholangitis.
is also such
becomes
nonop-
time
as
necessary.
We, too, are excited by the potential role of bile cytology in the evaluation of patients with sclenosing cholangitis/cholangiocamcinoma
and
are
just
beginning
to
investigate this potential in a systematic way. As our results become available, we will with
look forward those of Dr.
to comparing Lumsden and
them Dr. Als-
paugh. Robert L. MacCarty, M.D. Department of Diagnostic Mayo Clinic Rochester, MN 55905
Radiology
cholangio-
carcinoma develops as a complication. Consequently, we are currently obtaining bile specimens either by aspiration, brushing, or both during percutaneous cholangioplasty and stenting. The reported sensitivity of bile cytology for detecting malignancy ranges from 34% to 87% (2); however, there are no data in the litenatume concerning its value in sclenosing cholangitis where inflammatory activity may make cytologic interpretation difficult. Further evaluation is necessary. Primary sclemosing cholangitis is now being recognized with increased fmequency, and it is likely that this diagnostic dilemma will be encountered much more
Erratum Radiology
1985;
156:596
The Assessment Centres for diagnostic madiological equipment are operated under the auspices of the Department of Health and Social Security, London, England.
cytology
should be performed on all patients suspected of having sclenosing cholangitis, both initially and intermittently during follow-up,
to rule
out
cholangiocarci-
noma.
References 1.
dun2.
856
to 20%
therefore, is not completely The current trend for
sclenosing
Cholangiocarcinoma Complicating
in up
UDr.
MacCanty RL, LaRusso NF, May GR, et al. Cholangiocancinoma complicating primary sclenosing cholangitis: cholangiographic appearances. Radiology 1985; 156:43-46. Cohan RH, Illescas FF, Newman GE, Braun SD, Dunnick NR. Biliary cytodiagnosis: bile sampling for cytology. Invest Radiol 1985; 20:177-179.
March
1986
