Abstract
Cholangiocarcinoma (CCA) is the second most common primary liver tumor and it’s associated with a poor prognosis. They diagnosis of CCA can be challenging because of its paucicellular nature, anatomic location, and silent clinical character. Cross sectional radiologic studies (MRI/MRCP and multidetector CT scan) are critical for diagnosis and staging CCA but their sensibility is yet improvable and they don’t allow tissue acquisition. ERCP has been for years the modality of choice for evaluating and sampling biliary strictures for malignancy. New endoscopic techniques like EUS and cholangioscopy and advances in imaging technologies and cytology processing have the potential of significantly improve the preoperative diagnostic accuracy of this malignancy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Khan SA, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61(12):1657–69.
Vilgrain V. Staging cholangiocarcinoma by imaging studies. HPB (Oxf). 2008;10(2):106–9.
Rimola J, et al. Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology. 2009;50(3):791–8.
Bridgewater J, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60(6):1268–89.
Marrero JA, Ahn J, Rajender Reddy K. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014;109(9):1328–47; quiz 1348.
Aljiffry M, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990–2009. World J Gastroenterol. 2009;15(34):4240–62.
Lee HY, et al. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria. Radiology. 2006;239(1):113–21.
Aloia TA, et al. High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg. 2007;193(6):702–6.
Katabathina VS, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 2014;34(3):565–86.
Kim JY, et al. Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures. J Magn Reson Imaging. 2007;26(2):304–12.
Singh A, et al. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice. J Clin Diagn Res. 2014;8(3):103–7.
Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging. 2008;33(4):444–51.
Kim JY, et al. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol. 2008;103(5):1145–51.
Ruys AT, et al. Staging laparoscopy for hilar cholangiocarcinoma: is it still worthwhile? Ann Surg Oncol. 2011;18(9):2647–53.
Patel AH, et al. The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol. 2000;95(1):204–7.
Fritscher-Ravens A, et al. EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology. Am J Gastroenterol. 2004;99(1):45–51.
De Bellis M, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (part 1). Gastrointest Endosc. 2002;56(4):552–61.
Fogel EL, et al. Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. Gastrointest Endosc. 2006;63(1):71–7.
Rosch T, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc. 2004;60(3):390–6.
de Bellis M, et al. Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc. 2003;58(2):176–82.
Brugge WR, et al. Techniques for cytologic sampling of pancreatic and bile duct lesions: the Papanicolaou Society of Cytopathology Guidelines. Cytojournal. 2014;11 Suppl 1:2.
Curcio G, et al. Intraductal aspiration: a promising new tissue-sampling technique for the diagnosis of suspected malignant biliary strictures. Gastrointest Endosc. 2012;75(4):798–804.
Baron TH, et al. A prospective comparison of digital image analysis and routine cytology for the identification of malignancy in biliary tract strictures. Clin Gastroenterol Hepatol. 2004;2(3):214–9.
Levy MJ, et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol. 2008;103(5):1263–73.
Smoczynski M, et al. Routine brush cytology and fluorescence in situ hybridization for assessment of pancreatobiliary strictures. Gastrointest Endosc. 2012;75(1):65–73.
Mohamadnejad M, et al. Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc. 2011;73(1):71–8.
Ross WA, et al. Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy. Gastrointest Endosc. 2008;68(3):461–6.
Garrow D, et al. Endoscopic ultrasound: a meta-analysis of test performance in suspected biliary obstruction. Clin Gastroenterol Hepatol. 2007;5(5):616–23.
Heinzow HS, et al. Comparative analysis of ERCP, IDUS, EUS and CT in predicting malignant bile duct strictures. World J Gastroenterol. 2014;20(30):10495–503.
DeWitt J, et al. EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results. Gastrointest Endosc. 2006;64(3):325–33.
Byrne MF, et al. Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions. Endoscopy. 2004;36(8):715–9.
Gleeson FC, et al. EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc. 2008;67(3):438–43.
Heimbach JK, et al. Trans-peritoneal fine needle aspiration biopsy of hilar cholangiocarcinoma is associated with disease dissemination. HPB (Oxford). 2011;13(5):356–60.
Micames C, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003;58(5):690–5.
Ikezawa K, et al. Risk of peritoneal carcinomatosis by endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer. J Gastroenterol. 2013;48(8):966–72.
Kim JH, et al. Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics. 2002;22(6):1335–52.
Weilert F, et al. EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc. 2014;80(1):97–104.
Aslanian HR, et al. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography for obstructing pancreas head masses: combined or separate procedures? J Clin Gastroenterol. 2011;45(8):711–3.
Sai JK, et al. Early detection of extrahepatic bile-duct carcinomas in the nonicteric stage by using MRCP followed by EUS. Gastrointest Endosc. 2009;70(1):29–36.
Chalasani N, et al. Cholangiocarcinoma in patients with primary sclerosing cholangitis: a multicenter case-control study. Hepatology. 2000;31(1):7–11.
Burak K, et al. Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis. Am J Gastroenterol. 2004;99(3):523–6.
Chapman MH, et al. Cholangiocarcinoma and dominant strictures in patients with primary sclerosing cholangitis: a 25-year single-centre experience. Eur J Gastroenterol Hepatol. 2012;24(9):1051–8.
Bjornsson E, et al. Dominant strictures in patients with primary sclerosing cholangitis. Am J Gastroenterol. 2004;99(3):502–8.
Stiehl A, et al. Development of dominant bile duct stenoses in patients with primary sclerosing cholangitis treated with ursodeoxycholic acid: outcome after endoscopic treatment. J Hepatol. 2002;36(2):151–6.
Navaneethan U, et al. Fluorescence in situ hybridization for diagnosis of cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis. Gastrointest Endosc. 2014;79(6):943–50.e3.
Levy C, et al. The value of serum CA 19-9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis. Dig Dis Sci. 2005;50(9):1734–40.
Sinakos E, et al. Many patients with primary sclerosing cholangitis and increased serum levels of carbohydrate antigen 19-9 do not have cholangiocarcinoma. Clin Gastroenterol Hepatol. 2011;9(5):434–9.e1.
Rey JW, et al. Efficacy of SpyGlass(TM)-directed biopsy compared to brush cytology in obtaining adequate tissue for diagnosis in patients with biliary strictures. World J Gastrointest Endosc. 2014;6(4):137–43.
Tischendorf JJ, et al. Cholangioscopic characterization of dominant bile duct stenoses in patients with primary sclerosing cholangitis. Endoscopy. 2006;38(7):665–9.
EASL. Clinical practice guidelines: management of cholestatic liver diseases. J Hepatol. 2009;51(2):237–67.
Keane MG, Marlow NJ, Pereira SP. Novel endoscopic approaches in the diagnosis and management of biliary strictures. F1000Prime Rep. 2013;5:38.
Osanai M, et al. Peroral video cholangioscopy to evaluate indeterminate bile duct lesions and preoperative mucosal cancerous extension: a prospective multicenter study. Endoscopy. 2013;45(8):635–42.
Ramchandani M, et al. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc. 2011;74(3):511–9.
Nguyen NQ, Schoeman MN, Ruszkiewicz A. Clinical utility of EUS before cholangioscopy in the evaluation of difficult biliary strictures. Gastrointest Endosc. 2013;78(6):868–74.
Menzel J, et al. Preoperative diagnosis of bile duct strictures – comparison of intraductal ultrasonography with conventional endosonography. Scand J Gastroenterol. 2000;35(1):77–82.
Krishna NB, et al. Intraductal US in evaluation of biliary strictures without a mass lesion on CT scan or magnetic resonance imaging: significance of focal wall thickening and extrinsic compression at the stricture site. Gastrointest Endosc. 2007;66(1):90–6.
Stavropoulos S, et al. Intraductal ultrasound for the evaluation of patients with biliary strictures and no abdominal mass on computed tomography. Endoscopy. 2005;37(8):715–21.
Heif M, Yen RD, Shah RJ. ERCP with probe-based confocal laser endomicroscopy for the evaluation of dominant biliary stenoses in primary sclerosing cholangitis patients. Dig Dis Sci. 2013;58(7):2068–74.
Gabbert C, et al. Advanced techniques for endoscopic biliary imaging: cholangioscopy, endoscopic ultrasonography, confocal, and beyond. Gastrointest Endosc Clin N Am. 2013;23(3):625–46.
Arvanitakis M, et al. Intraductal optical coherence tomography during endoscopic retrograde cholangiopancreatography for investigation of biliary strictures. Endoscopy. 2009;41(8):696–701.
Kirtane TS, Wagh MS. Endoscopic optical coherence tomography (OCT): advances in gastrointestinal imaging. Gastroenterol Res Pract. 2014;2014:376367.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Waxman, I., Gonzalez-Haba, M. (2016). Assessment of Bile Duct Tumors: Endoscopic vs Radiographic. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_29
Download citation
DOI: https://doi.org/10.1007/978-3-319-27365-5_29
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-27363-1
Online ISBN: 978-3-319-27365-5
eBook Packages: MedicineMedicine (R0)