Intraductal Ultrasonography Before Biliary Drainage and Transpapillary Biopsy in Assessment of the Longitudinal Extent of Bile Duct Cancer

Abstract

Aim:We evaluated the diagnostic efficacy of transpapillary intraductal ultrasonography before biliary drainage (IDUS-BD) and transpapillary biopsy (TPB) for the assessment of the longitudinal extent of bile duct cancer. Methods: Between November 1999 and January 2005, we performed IDUS-BD and TPB preoperatively in 27 patients with carcinoma of the extrahepatic bile duct. Following IDUS-BD, TPB was performed under fluoroscopic guidance immediately after endoscopic sphincterotomy. The diagnostic efficacy of IDUS-BD and TPB for the longitudinal extent of the cancer and the complications which accompanied the procedure were evaluated. Results: The overall success rate of sampling and the diagnostic accuracy of bile duct cancer by TPB were 85.3% (192/225) and 85% (23/27), respectively. The sensitivity, specificity and accuracy of the assessment of the longitudinal extent of cancer on the hepatic and duodenal sides by IDUS-BD were 82%, 70%, 78% and 85%, 43%, 70%, respectively. Those by a combination of IDUS-BD and TPB were 88%, 80%, 85% and 77%, 86%, 80%, respectively. Overestimation of the longitudinal extent of BD cancer by IDUS-BD was mainly due to inflammation and obscure images, especially resulting from collapse of the bile duct on the duodenal side of the tumor, and was corrected by TPB in four of five patients. No serious complications occurred following the combination of IDUS-BD and TPB. Conclusions: TPB is useful for preoperative histological diagnosis of bile duct cancer. The combination of IDUS-BD and TPB is practical for evaluation of its longitudinal extent; basically, IDUS-BD is sufficient on the hepatic side of the tumor, but concomitant TPB is recommended on the duodenal side.

Endoscopic diagnosis of pancreaticobiliary maljunction

“…IDUS is also useful for the diagnosis of bile duct can cer ( Figure 6B) [15,16] . However, IDUS has limitations for the diagnosis of bile duct and gallbladder lesions because of shallow US penetration (< 2.0 cm) and maneuverability of passage of probe in case of bile duct stricture or a nar row cystic duct.…”

Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseases

“…Many reports have addressed improvement of accuracy in diagnosing bile duct cancer with the combined use of IDUS and biopsy including assessment of molecular markers [35,36,38,42,45], either transhepatically or transpapillarily. Three-dimensional IDUS is also available for biliary/pancreatic IDUS.…”

“…As mentioned above, the longitudinal spread of the bile duct cancer from the main tumour is visualised by IDUS as an irregular and asymmetric thickening of the wall. It is necessary to perform IDUS before establishing biliary drainage as it causes thickening of the bile duct wall, which mimics cancer extension [28, 31,32,45] Although the number of patients included was small, Tamada et al [48] reported the accuracy of IDUS in the evaluation of longitudinal spread of bile duct cancer to be only 50% (four out of eight cases), even with 3-D imaging. Noda et al [45] carried out a comparative study of preoperative IDUS with histological findings in surgical cases with bile duct cancer.…”

Usefulness of Intraductal Ultrasonography in the Diagnosis of Cholangiocarcinoma and IgG4-Related Sclerosing Cholangitis

“…Percutaneous transhepatic cholangioscopy and biopsy require considerable time and pose a risk of cancer dissemination 3. Transpapillary biopsy and IDUS are expected to be alternatives to percutaneous transhepatic cholangioscopy and biopsy for the preoperative histological diagnosis and estimation of the longitudinal extent of CC 4,5. At present, IDUS is probably the most useful modality to estimate the longitudinal extent of CC 4,5.…”