Proximal bile duct stricture disguised as malignant neoplasm

Nakayama, Ataru; Imamura, Hiroshi; Shimada, Ryo; Miyagawa, Shinichi; Makuuchi, Masatoshi; Kawasaki, Seiji

doi:10.1016/s0039-6060(99)70203-5

Cited by 45 publications

(22 citation statements)

References 23 publications

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“…The diagnostic value of tumor markers such as CA 19-9 and CEA in biliary cancer has been extensively studied. One study showed 100% sensitivity using a combination of CA 19-9 and CEA [19] , but these results could not be confirmed by other workers [9,10] . Another, potentially useful test is serum IgG4.…”

Section: Discussionmentioning

confidence: 85%

“…Several studies have noted that approximately 14% to 25% of patients resected for presumed HCCA prove to have a benign lesion at histopathology [10][11][12][13][14] . A recent study attempted to identify potential criteria for distinguishing patients with HCCA from those with an alternative diagnosis [15] .…”

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: Discussionmentioning

confidence: 85%

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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“…It is also reported that there are considerable amounts of benign bile duct stricture cases that are diagnosed as bile duct carcinoma by preoperative images and that undergo surgical resection [68]. Therefore, histological or cytological diagnosis should be performed for patients who are suspected to have resectable bile duct carcinoma.…”

Section: Cq2: Is a Cholecystectomy Necessary For Polypoid Lesions Of mentioning

confidence: 99%

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Miyazaki

Yoshitomi

Miyakawa³

et al. 2015

J Hepato Biliary Pancreat

234

165

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Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidencebased approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via

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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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Proximal bile duct stricture disguised as malignant neoplasm

Cited by 45 publications

References 23 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

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Surgical strategy for bile duct cancer: Advances and current limitations

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Proximal bile duct stricture disguised as malignant neoplasm

Cited by 45 publications

References 23 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

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

Surgical strategy for bile duct cancer: Advances and current limitations

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Product

Resources

About

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition