Radiological findings and surgical outcomes of pulmonary metastases originating from biliary tract carcinoma
Metastasis to the lungs arising from biliary tract carcinoma (BTC) is extremely rare, and the patient characteristics and prognosis are not well known. We aimed to identify the imaging findings of pulmonary metastases originating from BTC and the eligible indications for surgical treatment.
Fifteen patients who underwent pulmonary resection for metastases originating from BTC were retrospectively analyzed.
The primary sites included cholangiocarcinoma (n = 12) and gallbladder carcinoma (n = 3), and all cases were histologically diagnosed as well to moderately differentiated adenocarcinomas. The median disease-free interval between resection for the primary site and the detection of pulmonary metastasis was 30 months (range 0–144 months). Nine patients had a single lesion, and six had multiple lesions. As features of pulmonary lesions on thin-section computed tomography (CT), many appeared as solid nodules with smooth margins, whereas six lesions were concomitant with spiculation or pleural indentation, three with air bronchogram or ground-glass attenuation, and one with intra-tumoral cavity, and six cases with solitary pulmonary lesion were diagnosed as primary lung cancer before metastasectomy. The 3-year survival rate in the 11 patients who underwent complete metastasectomy was 45%. A disease-free interval of more than 3 years (p = 0.03) and single lesion (p < 0.01) were significant prognostic factors.
The CT findings of pulmonary metastases from BTCs sometimes resemble the characteristic findings of primary lung cancer. A long disease-free interval and single lesion are therefore considered to be good surgical indicators.
KeywordsBiliary tract carcinoma Computed tomography Pulmonary metastases Metastasectomy Radiological findings
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest in association with this study.
- 10.Miyazaki M, Ohtsuka M, Miyakawa S, Nagino M, Yamamoto M, Kokudo N et al (2015) Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3rd English edition. J Hepatobiliary Pancreat Sci 22:181–196Google Scholar
- 11.Miyazaki M, Yoshitomi H, Miyakawa S, Uesaka K, Unno M, Endo I et al (2015) Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition. J Hepatobiliary Pancreat Sci 22:249–273Google Scholar
- 12.Saxena A, ChuaTC, Chu FC, Morris DL (2011) Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg 202:310–320.Google Scholar
- 18.Park SY, Kim BH, Kim JH, Lee S, Kang GH. Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma. Arch Pathol Lab Med. 2007;131:1561–7.Google Scholar