Kloek JJ, Delden OMV, Erdogan D, Kate FJT, Rauws EA, Busch OR, Gouma DJ, Gulik TMV. Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma. World J Gastroenterol 2008; 14(32): 5032-5038 [PMID: 18763286 DOI: 10.3748/wjg.14.5032]
Corresponding Author of This Article
Thomas Mathijs van Gulik, MD, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam 1100 DE, Netherlands. t.m.vangulik@amc.uva.nl
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Rapid Communication
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World J Gastroenterol. Aug 28, 2008; 14(32): 5032-5038 Published online Aug 28, 2008. doi: 10.3748/wjg.14.5032
Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma
Jaap Jacob Kloek, Otto Marinus van Delden, Deha Erdogan, Fibo Jan ten Kate, Erik Anthoni Rauws, Olivier Robert Busch, Dirk Joan Gouma, Thomas Mathijs van Gulik
Jaap Jacob Kloek, Deha Erdogan, Olivier Robert Busch, Dirk Joan Gouma, Thomas Mathijs van Gulik, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam 1100 DE, Netherlands
Otto Marinus van Delden, Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam 1100 DE, Netherlands
Fibo Jan ten Kate, Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam 1100 DE, Netherlands
Erik Anthoni Rauws, Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DE, Netherlands
Author contributions: Kloek JJ, van Delden OM, Erdogan D, Rauws EA, ten Kate FJ, Busch OR, Gouma DJ and van Gulik TM designed the research; Kloek JJ, van Delden OM, ten Kate FJ, Rauws EA, Busch OR, Gouma DJ performed research; Kloek JJ, van Delden OM and Erdogan D, and van Gulik TM analyzed the data; and Kloek JJ, van Delden OM, Erdogan D, and van Gulik TM wrote the paper.
Correspondence to: Thomas Mathijs van Gulik, MD, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam 1100 DE, Netherlands. t.m.vangulik@amc.uva.nl
Telephone: +31-20-5665572 Fax: +31-20-6976621
Received: May 20, 2008 Revised: June 30, 2008 Accepted: July 6, 2008 Published online: August 28, 2008
Abstract
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.
