Die Diagnostik des hilären Cholangiokarzinoms: Wertigkeit von präoperativer ERC, MRC und PTC im Vergleich zur Histopathologie

Abstract

The management of patients with hilar cholangiocarcinoma requires a high degree of expertise in diagnostic imaging techniques. Cholangiography should not only define the location but also visualize the uppermost extent of the tumor to determine resectability. In contrast to most reports in the literature, ERC and MRC were found to be of limited reliability regarding the assessment of the tumor extent. ERC may be more and more reserved for patients considered for nonsurgical intervention or palliation. PTC proved to be the most reliable approach. MRC represents a noninvasive diagnostic tool for the evaluation of malignant perihilar biliary obstructions, but should be performed at highest quality using state-of-the-art MRI techniques. The most common mistake of each diagnostic modality was an overestimated tumor extent, which may exclude patients from potentially curative surgery.

Detection of benign hilar bile duct stenoses - A retrospective analysis in 250 patients with suspicion of Klatskin tumour

“…PTC provide information on the longitudinal expansion of the stenosis, which is crucial to plan surgical approach [7] , [8] , [9] . Furthermore, percutaneous transhepatic cholangiography (PTC) allows the placement of selective and multiple percutaneous drainages (PTCD), resulting in a more rapid removal of obstructive cholestasis [29] .…”

“…In comparison to ERC, PTC allows a better visualisation of longitudinal tumour growth, which is crucial to plan and perform a more aggressive surgical approach [7] , [8] , [9] . PTCD can remain in place and may subsequently be used for palliative treatment like photodynamic therapy.…”