Intrabiliary Growth of Colorectal Liver Metastasis: Spectrum of Imaging Findings and Implications for Surgical Management

Peungjesada, Silanath; Aloia, Thomas A.; Kaur, Harmeet; Marcal, Leonardo P.; Choi, Haesun; Vauthey, Jean Nicolas; Loyer, Evelyne M.

doi:10.2214/ajr.12.9508

Cited by 19 publications

(13 citation statements)

References 10 publications

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“…More economical surgical approaches increase the risk of recurrence due to the existence of an R1 margin in the bile duct [5,22,31]. Peungjesada et al [32] affirm that the hallmark and risk of bile duct involvement by colorectal liver metastasis is that the tumors can grow longitudinally, extending beyond the confines of the main parenchymal neoplastic mass. In nonanatomic wedge resection, the surgical margin may be too narrow to encompass the involved duct or ducts.…”

Section: Discussionmentioning

confidence: 99%

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Intrabiliary metastases in colorectal cancer: a systematic review

Fragua

Vázquez

Figueira

et al. 2019

J Hepato Biliary Pancreat

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Background Liver metastases emerge during the course of colorectal cancer (CRC) in 25–50% of patients. A small proportion of patients present intrabiliary growth. The absence of large series means that little is known about intrabiliary metastasis (IBM), its radiological diagnosis, the most suitable surgical techniques, and its prognostic implications. Methods A systematic search without limits was performed. The studies selected included patients with a diagnosis of CRC and associated IBM, either synchronous or metachronous. Results Of 40 studies selected, 30 were case reports and 10 case series. The median time between diagnosis and IBM was 46.7 months (range 0–180). Most CRC metastases are CK7−/CK20+. Surgical treatment performed ranged from endoscopic resection to major hepatic resections combined with pancreatectomies. It seems that patients with IBM have a better survival than patients without this metastasis. Conclusion In a patient with a history of CRC presenting dilatation of the bile duct, IBM should be considered. More studies are needed to determine the most appropriate type of liver resection. It is also necessary to standardize the definition and terminology of this pathology, since the existing definitions may cause confusion and make it difficult to carry out case studies and case series.

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Section: Discussionmentioning

confidence: 99%

“…Pathological differentiation between intrahepatic cholangiocarcinoma and IBM is complex when using only hematoxylin-eosin, but the use of CK facilitates the diagnosis [2,4,32]. The combination of CK7 and CK20 is very useful [4,6,20,30,33].…”

Section: Discussionmentioning

confidence: 99%

Intrabiliary metastases in colorectal cancer: a systematic review

Fragua

Vázquez

Figueira

et al. 2019

J Hepato Biliary Pancreat

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“…Jaundice and increasing carcinoembryonic antigen (CEA) are the most frequent clinical signs raising the suspicion of intrabiliary colorectal metastases, however, these signs do not allow differentiation from alternative diagnosis [ 5 ]. Computerized tomography (CT), which is commonly used for monitoring of colorectal cancer, does not reliably make a diagnosis of intrabiliary colorectal metastases [ 6 ]. CT changes can be subtle and dilation of ducts may be the only identifiable abnormality [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Intrabilary obstruction by colorectal metastases

Traeger

Kiroff

2018

Journal of Surgical Case Reports

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Intrabiliary colorectal metastases are rare. We present a case of an 84-year-old man who developed obstructive jaundice secondary to intrabiliary growth of colorectal metastases. The patient presented with three weeks of jaundice and significant weight loss in the preceding months. The patient’s background included metastatic colorectal carcinoma, with a previous right hemicolectomy and left hepatectomy for liver metastases. A MRCP showed an obstruction of the biliary tract transitioning at the ampulla. Histology confirmed a malignant adenocarcinoma. When compared to the patient’s previous resected colorectal liver metastases, morphology and immunohistochemistry was consistent with colorectal metastases. This case highlights the importance of differentiating a new intraductal papillary neoplasm from a colorectal metastasis. Correctly identifying these lesions requires the use of MRCP and ERCP, as well as immunohistochemistry. This is a priority for clinicians to ensure appropriate therapy.

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“…Similarly, the phenomenon of insufficient margins with biliary invasion should be considered for local therapies such as RFA, as it puts the patient at risk for a higher likelihood of local recurrence. A parenchymal metastatic lesion associated with dilated biliary ducts, either upstream or downstream, suggests ductal invasion [39].…”

Section: Critical Imaging Findings To Reportmentioning

confidence: 99%

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

et al. 2015

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Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.

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Intrabiliary Growth of Colorectal Liver Metastasis: Spectrum of Imaging Findings and Implications for Surgical Management

Abstract: Knowledge of the imaging features of intrabiliary invasion by colorectal liver metastasis improves the quality of preoperative staging and is crucial in an era in which nonanatomic wedge resection and radiofrequency ablation are routinely performed.

Cited by 19 publications

References 10 publications

Intrabiliary metastases in colorectal cancer: a systematic review

Intrabiliary metastases in colorectal cancer: a systematic review

Intrabilary obstruction by colorectal metastases

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

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