Incidence of benign lesions in patients resected for suspicious hilar obstruction

Gerhards, Michael F.; Vos, Pieter C.; Gulik, Thomas M. Van; Rauws, Erik A.; Bosma, A.; Gouma, Dirk J.

doi:10.1046/j.1365-2168.2001.01607.x

Cited by 180 publications

(125 citation statements)

References 6 publications

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“…In the present study, the rate of patients (15%) with benign lesions misdiagnosed as malignancy was similar to the rate (15%) observed in a previous study performed at our center a decade earlier (1983-1997) [16] . Despite considerable improvements in imaging techniques (contrast enhanced multi-slice CT and MRC), and an increase in the number of imaging procedures (a mean of 3 modalities in comparison to 2 in the previous study), patients still required unnecessary extensive resections, for achieving adequate biliary drainage.…”

Section: Discussionsupporting

confidence: 75%

“…However, the non-HCCA patients in this series comprised of benign and malignant diseases (for instance gallbladder cancer), which makes any conclusions difficult to interpret. In a previous series of 132 patients who had undergone surgical treatment for suspicious HCCA at our center from 1983 to 1998, 15% (20/132) of the patients had benign lesions [16] . In the present study, which covers a more recent period during which improved imaging techniques were used, the rate of mis-diagnosed benign lesions was reexamined and the diagnostic features of benign and malignant lesions was compared.…”

Section: Jj Et Al Differentiation Of Proximal Bile Duct Strictures mentioning

confidence: 99%

“…Hadjis et al 1985 [34] 1979-1983 104 3 8 (8) Wetter et al 1991 [35] 1985-1990 59 4 8 (14) Verbeek et al 1992 [36] 1984-1990 82 11 (13) Nakayama et al 1999 [10] 1990-1997 99 14 (15) Gerhards et al 2001 [16] 1983-1997 132 20 (15) Knoefel et al 2003 [12] 1996-1999 33 6 (18) Khalili et al 2003 [13] 2000-2001 20 4 (20) Koea et al 2004 [37] 1998-2002 49 12 (24) Corvera et al 2005 [38] 1992-2003 275 3 22 ( 8) Are et al 2006 [15] 1997-2001 59 9 (15) Uhlmann et al 2006 [39] 1998 out of 68 (15%) patients with presumed HCCA, were misdiagnosed. Vascular involvement showed a significant association with malignant lesions.…”

Section: Number Of Benign Lesions (%)mentioning

confidence: 99%

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Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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Section: Discussionsupporting

confidence: 75%

Section: Jj Et Al Differentiation Of Proximal Bile Duct Strictures mentioning

confidence: 99%

Section: Number Of Benign Lesions (%)mentioning

confidence: 99%

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Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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“…Unfortunately, these histopathologic examinations yield low sensitivity, and non-diagnostic cytology or biopsy results may not rule out cholangiocarcinoma in the presence of appropriate radiologic findings [79,80] . In the absence of other explainable causes of biliary strictures, patients should be assumed to have cancer and operated on as such, accepting that 10% to 15% might prove to have a benign lesion on the final histologic investigation [81,82] . Fukuda et al [83] reported 100% sensitivity of bile duct biopsy by adding choledochoscopy to ERC, and a new technology such as SpyGlass ® , which is currently under investigation, may soon improve the diagnostic accuracy of preoperative malignancy confirmation [84,85] .…”

Section: Duct Cancermentioning

confidence: 99%

Surgical strategy for bile duct cancer: Advances and current limitations

Akamatsu

Sugawara²,

Hashimoto³

2011

WJCO

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The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon's ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud's segment Ⅳ coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pyloruspreserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy.

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“…Imaging findings representative of this disease include biliary stricture associated with dilatation of the peripheral bile duct and lymph node enlargement. Certain patients have undergone surgical treatment for preoperative diagnosis of cholangiocarcinoma, which was finally diagnosed as a benign condition (10).…”

Section: Introductionmentioning

confidence: 99%

Follicular cholangitis associated with focal biliary stricture treated with left hepatectomy after 8 years of follow-up: A rare case report

Saito

Fukuda

Amano

et al. 2015

Molecular and Clinical Oncology

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Abstract. Follicular cholangitis may lead to severe focal biliary stricture, which is difficult to distinguish from cholangiocarcinoma. This is the report of a rare case of follicular cholangitis associated with an intrahepatic focal biliary stricture in a 69-year-old woman. The patient visited our hospital for upper abdominal pain in 2006. Computed tomography revealed common bile duct stones and focal stricture of the left intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a severe B3 stricture and dilation of the peripheral biliary tract. Repeated cytology revealed no malignancy. The patient was followed up for 8 years and repeated attacks of cholangitis severely compromised her quality of life. A left hepatectomy was performed, and the pathological findings were consistent with follicular cholangitis. It is generally difficult to make a definitive diagnosis after identifying a biliary stricture, and the stricture is often treated with surgical resection. The clinical presentation and radiological findings of follicular cholangitis are similar to those of cholangiocarcinoma; therefore, if a conservative approach is selected, frequent follow-up is recommended. The present case suggests that follicular cholangitis should be considered in the differential diagnosis of biliary stricture. IntroductionFollicular cholangitis is difficult to diagnose, as it is particularly challenging to distinguish from primary sclerosing cholangitis, immunoglobulin G4 (IgG4)-related sclerosing cholangitis and hilar cholangiocarcinoma (1-4). Follicular cholangitis is relatively rare; it was first reported by Aoki et al (5) in 2003, and only a few cases have been reported to date (5-9). Imaging findings representative of this disease include biliary stricture associated with dilatation of the peripheral bile duct and lymph node enlargement. Certain patients have undergone surgical treatment for preoperative diagnosis of cholangiocarcinoma, which was finally diagnosed as a benign condition (10).It was previously demonstrated that the majority of the cases are diagnosed as cholangiocarcinoma due to the severe biliary stricture and the presence of symptoms, which commonly include abdominal pain and jaundice. Follicular cholangitis has recently been reported to be among several diseases that cause biliary stricture. The reported pathological findings of this disease are fibrotic thickening of the wall of the hilar bile duct; prominent hyperplastic lymph follicles with germinal centers in the subserosal layer, without tumorous growth, which were considered to be reactive hyperplastic follicles, with localization of the lesions in the proximal extrahepatic bile duct and hepatic hilum, and with almost intact peripheral intrahepatic bile ducts (8).We herein report the case of a 69-year-old woman with follicular cholangitis associated with a focal biliary stricture, who underwent left hepatectomy after 8 years of follow-up. Case reportA 69-year-old woman was referred to our hospital due to repeated hepatolithiasis and c...

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Incidence of benign lesions in patients resected for suspicious hilar obstruction

Abstract: Because of the limitations of current diagnostic tools, a false-positive preoperative diagnosis of malignancy resulted in a 15 per cent resection rate of benign lesions in this series of suspicious hilar strictures.

Cited by 180 publications

References 6 publications

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Surgical strategy for bile duct cancer: Advances and current limitations

Follicular cholangitis associated with focal biliary stricture treated with left hepatectomy after 8 years of follow-up: A rare case report

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