Prospective study of biliary cytology in suspected perihilar cholangiocarcinoma

Hattori, Masashi; Nagino, Masato; Kato, Kazushige; Okada, K.; Shimoyama, Yoshie

doi:10.1002/bjs.7412

Cited by 35 publications

(24 citation statements)

References 52 publications

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“…Hence, the sensitivity of conventional cytology in perihilar cholangiocarcinoma is approximately 20%. 57 The vast majority of perihilar cholangiocarcinomas are periductal, infiltrating cancers, and as such do not demonstrate mass lesions on cross-sectional imaging studies. The lack of a mass lesion precludes percutaneous biopsy techniques.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Clinical diagnosis and staging of cholangiocarcinoma

Blechacz

Komuta

Roskams

et al. 2011

Nat Rev Gastroenterol Hepatol

634

541

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Cholangiocarcinoma is the most frequent biliary malignancy. It is difficult to diagnose owing to its anatomic location, growth patterns and lack of definite diagnostic criteria. Currently, cholangiocarcinoma is classified into the following types according to its anatomic location along the biliary tree: intrahepatic, perihilar or distal extrahepatic cholangiocarcinoma. These cholangiocarcinoma types differ in their biological behavior and management. The appropriate stratification of patients with regard to the anatomic location and stage of cholangiocarcinoma is a key determinate in their management. Staging systems can guide this stratification and provide prognostic information. In addition, staging systems are essential in order to compare and contrast the outcomes of different therapeutic approaches. A number of staging systems exist for cholangiocarcinoma—several early ones have been updated, and new ones are being developed. We discuss the emerging diagnostic criteria as well as the different staging systems for cholangiocarcinoma, and provide a critical appraisal regarding these advances in biliary tract malignancies.

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Section: Diagnostic Criteriamentioning

confidence: 99%

Clinical diagnosis and staging of cholangiocarcinoma

Blechacz

Komuta

Roskams

et al. 2011

Nat Rev Gastroenterol Hepatol

634

541

View full text Add to dashboard Cite

show abstract

“…As patients with biliary tract cancers contain floating cancer cells in the bile [12], bile spillage potentially leads to the development of peritoneal dissemination [13]. Several studies [14–16] on this issue demonstrate that early relapse generally occurs after additional resection for the spillage-induced dissemination, leading to dismal prognosis.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival after multidisciplinary therapy for residual gallbladder cancer with peritoneal dissemination: a case report

et al. 2017

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BackgroundAlthough surgical resection is the only curative treatment for gallbladder cancer (GBC), concomitant peritoneal dissemination is considered far beyond the scope of resection. We report a long-term survivor with a residual GBC with multiple peritoneal disseminations who underwent an extended resection after effective chemotherapy.Case presentationA 59-year-old male underwent an open cholecystectomy for Mirizzi syndrome at a local hospital. Because of severe inflammation, the gallbladder was perforated during surgery, ending in a piecemeal resection. A pathological examination revealed GBC with positive margins, and the patient was referred to our hospital 1 month after surgery for further treatment. A multidetector-row computed tomography (MDCT) showed three hypoattenuated tumours: a tumour (3.9 cm) at the left medial segment corresponding to the gallbladder bed, a tumour (1.8 cm) around the hepatic flexure of the transverse colon, and a tumour (1.0 cm) at the stump of the cystic duct. Percutaneous needle biopsy was performed, which provided histologic evidence of adenocarcinoma. Thus, the patient had a rapidly progressive local relapse with limited peritoneal dissemination, labelled ycT3N0M1, stage IVB disease according to the UICC system. After the administration of 3 cycles of gemcitabine plus cisplatin combination chemotherapy, the size of all tumours and the CA19-9 level decreased significantly. Since the patient’s general condition and liver function reserve were satisfactory, we decided the initial unresectable scenario to perform surgical therapy. After portal vein embolization, right hepatectomy, resection of the extrahepatic bile duct, partial duodenectomy, and partial colectomy were performed. Operative time was 555 min, and intraoperative blood loss was 1654 mL. Pathologic diagnosis of residual gallbladder carcinoma with peritoneal dissemination was confirmed, and the surgical margins were tumour-free. The patient was discharged on postoperative day 29, with a Clavien-Dindo IIIa complication (abdominal wall abscess). Postoperative adjuvant chemotherapy with tegafur/gimeracil/oteracil was administered during 1 year after surgery. The patient is doing well 6 years after the second surgery without evidence of disease.ConclusionsAlthough specific clinical factors were associated with a favourable outcome in this patient, the present report suggests that multidisciplinary therapy may be a promising option in selected patients with distant metastatic GBC.

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“…Only positive results were categorized in the positive cytology group, and the other groups (suggestive of malignancy and negative results) were categorized in the negative cytology, as previously reported. 6 …”

Section: Biliary Cytologymentioning

confidence: 97%