Intraductal Ultrasound for the Evaluation of Patients with Biliary Strictures and No Abdominal Mass on Computed Tomography

Stavropoulos, Stavros N.; Larghi, Alberto; Verna, Elizabeth C.; Battezzati, Pier Maria; Stevens, P.

doi:10.1055/s-2005-870132

Cited by 101 publications

(55 citation statements)

References 13 publications

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“…More recently, techniques such as intraductal ultrasound (IDUS) and cholangioscopy have been used to obtain direct biopsy specimens. IDUS with biopsy increased the accuracy of ERCP from 58%-60% to 83%-90% in distinguishing benign and malignant strictures [33] . These diagnostic modalities appear very promising in differentiating benign and malignant biliary lesions, although they are highly expert-dependent and are still not widely available.…”

Section: Discussionmentioning

confidence: 99%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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Section: Discussionmentioning

confidence: 99%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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“…In a prospective study of 62 patients with biliary strictures, IDUS had a diagnostic sensitivity of 90% and specificity of 93% [143] . In another study by Stavropoulos et al [144] , IDUS increased the diagnostic accuracy of ERCP from 58% to 90% in a series of patients with biliary strictures and no mass detected on CT.…”

Section: Intraductal Ultrasound (Idus)mentioning

confidence: 99%

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Aljiffry¹,

Walsh²,

Molinari³

2009

WJG

254

190

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Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/ magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.

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“…Intraductal ultrasonography can provide the local staging to select patients with cholangiocarcinoma who benefit from surgical resection [43][44][45][46] . Recently, Stavropoulos et al [47] reported that intraductal ultrasonography increased the www.wjgnet.com…”

Section: Intraductal Ultrasonographymentioning

confidence: 99%

Diagnostic approaches for cholangiocarcinoma

Weber

Schmid²,

Prinz³

2008

WJG

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Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fineneedle aspiration. In the future, new techniques allowing for early detection, including molecular m a r ke r s , s h o u l d b e d e ve l o p e d t o i m p rove t h e diagnostic sensitivity in this increasing tumor entity.

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Intraductal Ultrasound for the Evaluation of Patients with Biliary Strictures and No Abdominal Mass on Computed Tomography

Abstract: IDUS is a valuable adjunct to ERCP in the characterization of biliary strictures in patients who present with painless jaundice in the absence of a culprit mass on abdominal imaging.

Cited by 101 publications

References 13 publications

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Diagnostic approaches for cholangiocarcinoma

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