Adult bile duct strictures: differentiating benign biliary stenosis from cholangiocarcinoma

Abstract

Biliary epithelial cells preferentially respond to various insults under chronic pathological conditions leading to reactively atypical changes, hyperplasia, or the development of biliary neoplasms (such as biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, and cholangiocarcinoma). Moreover, benign biliary strictures can be caused by a variety of disorders (such as IgG4-related sclerosing cholangitis, eosinophilic cholangitis, and follicular cholangitis) and often mimic malignancies, despite their benign nature. In addition, primary sclerosing cholangitis is a well-characterized precursor lesion of cholangiocarcinoma and many other chronic inflammatory disorders increase the risk of malignancies. Because of these factors and the changes in biliary epithelial cells, biliary strictures frequently pose a diagnostic challenge.Although the ability to differentiate neoplastic from non-neoplastic biliary strictures has markedly progressed with the advance in radiological modalities, brush cytology and bile duct biopsy examination remains effective. However, no single modality is adequate to diagnose benign biliary strictures because of the low sensitivity. Therefore, understanding the underlying causes by compiling the entire clinical, laboratory, and imaging data; considering the underrecognized causes; and collaborating between experts in various fields including cytopathologists with multiple approaches is necessary to achieve an accurate diagnosis.

Integrating next-generation sequencing to endoscopic retrograde cholangiopancreatography (ERCP)-obtained biliary specimens improves the detection and management of patients with malignant bile duct strictures

“…Malignant causes include carcinomas involving the pancreatobiliary ducts, ampulla of Vater, liver and, rarely, metastatic cancers. However, differentiating between benign and malignant bile duct strictures can be challenging and relies on a multidisciplinary approach of clinical examination, biochemical testing (eg, serum CA19-9), radiographic imaging, endoscopic procedures and pathological evaluation with ancillary studies 2. This distinction is more arduous considering the aetiology of some benign strictures can be a predisposing factor for malignancy.…”

Pilot Multi-Omic Analysis of Human Bile from Benign and Malignant Biliary Strictures: A Machine-Learning Approach

“…Regarding pancreatobiliary diseases, the accurate etiological diagnosis of biliary stenoses remains a clinical challenge. Strictures of the common bile duct may have a diverse origin [25], and the discrimination between benign and malignant stenoses in early stages has not been satisfactorily achieved yet [26]. Benign conditions include primary sclerosing cholangitis, chronic pancreatitis, choledocolithiasis, bile duct injury and infections, among others.…”

“…Benign conditions include primary sclerosing cholangitis, chronic pancreatitis, choledocolithiasis, bile duct injury and infections, among others. Malignant stenoses are mostly attributable to neoplasias arising from the biliary tree, such as cholangiocarcinoma (CCA) or gallbladder carcinoma, or from the pancreas as in the case of pancreatic ductal adenocarcinoma (PDAC) [26][27][28][29]. CCAs and PDACs are very aggressive neoplasms, and therefore their early diagnosis is essential for the application of potentially curative surgical procedures and/or pharmacological therapies [30,31].…”

A Resected Case of Follicular Cholangitis That Was Positive on ¹⁸F-fluorodeoxyglucose-positron Emission Tomography

“…Benign biliary strictures can be caused by various disorders, including immune-mediated disorders, such as PSC and IgG4-related disease; iatrogenic factors, including surgery and radiation; and choledocolithiasis, sphincter Oddi dysfunction, pancreatitis, Mirizzi syndrome, vascular, infection, and other rare diseases, such as follicular cholangitis (9). Their clinical features often mimic malignancies, despite their benign nature.…”