Staging of hilar cholangiocarcinoma with ultrasound

Abstract

The preoperative assessment of the extent of biliary and vascular involvement by hilar cholangiocarcinoma is clinically important because resectability may be limited by tumor extension along the bile ducts into the hepatic parenchyma or to the adjacent hilar vessels. Thirty-five patients with hilar cholangiocarcinoma were studied with ultrasound, and the results were compared with operative findings and other diagnostic modalities. The level of intrahepatic biliary obstruction was determined in 100% of patients with ductal ectasia, and a tumor mass was shown in 37.1%. Imaging and Doppler ultrasound proved accurate in detecting the neoplastic involvement of the portal vein. Both correctly diagnosed portal occlusion and wall infiltration in 4 of 4 and 15 of 18 (83%) patients, respectively, without any false-positives. On the contrary, imaging ultrasound had poor sensitivity in detecting infiltration of the hepatic artery (43%) and metastases in regional lymph nodes (37%), liver (66%), and peritoneum (33%). In conclusion, ultrasound may be valuable in the preoperative staging of hilar cholangiocarcinoma, specially in predicting ductal and portal involvement.

The Use of Imaging in the Diagnosis and Staging of Hepatobiliary Malignancies

“…The level of biliary obstruction was also determined accurately by ultrasonography in 100% of cases [54]. Similarly, in an Italian study of 35 patients with hilar cholangiocarcinoma, the level of biliary obstruction was accurately determined in 100% of patients using ultrasonography [55]. Portal vein occlusion was correctly diagnosed in four of four patients, and portal vein wall infiltration was shown in 15 of 18 patients without any false-positive results.…”

“…In another series of 63 consecutive patients with hilar cholangiocarcinoma, duplex ultrasonography predicted portal vein involvement with a 93% sensitivity, 99% specificity, and a 97% positive predictive value [56]. The major limitation of ultrasonography is its inability to consistently determine the precise extent of extraductal extension of tumor within the liver [54] In addition, ultrasonography very has limited sensitivity in detecting tumor infiltration of the hepatic artery (43%), metastases to regional lymph nodes (37%), peritoneal deposits (33%), and satellite liver lesions (66%) [55].…”

Surveillance in cholangiocellular carcinoma

“…The accuracy of CCA detection has been shown to exceed 80% in specialized centres [46,47]. When contrast agents are used, sensitivities of up to 100% have been described [48].…”

Imaging and interventions in hilar cholangiocarcinoma: A review

“…Lobar atrophy is seen in about 14% of patients with CC [16] . Sonography also helps in evaluation of vascular structures, regional nodes and liver.The accuracy of lesion detection on USG is about 82% and the sensitivity and specificity of portal vein involvement is 75%-83% and 93%-100%, respectively [15,17] . USG has low accuracy for hepatic artery involvement.…”