EFFICIENCY OF ULTRASOUND STUDY IN THE DIAGNOSIS OF CHOLANGIOCELLULAR CARCINOMA

Objective: to evaluate the efficiency of ultrasound diagnosis in detecting and staging cholangiocellular carcinoma.

Material and methods. An ultrasound study (USS) was conducted in 120 patients aged 19 to 84 years with cholangiocellular carcinoma. The patients were divided into 3 groups by the location of a tumor process: 1) 47 (39.2%) patients with intrahepatic tumor; 2) 49 (40.8%) with portal duct or Klatskin’s tumor; 3) 24 (20%) with distal one. Ninety (75%) patients were operated on; the others underwent minimally invasive X-ray surgical interventions as percutaneous transhepatic cholangiostomies. The data of ultrasound diagnosis were compared with the results of other studies, intraoperative assessment and morphological examination of a removed gross specimen.

Results. A tumor was detectable by USS only in 90 (75%) patients; its sensitivity was 100% for intrahepatic cholangiocellular carcinoma; 69.4 and 37.5% for portal duct and distal ones, respectively. It is most difficult to diagnose distal carcinomas of the common bile duct. USS reveals no semiotic signs of intrahepatic cholangiocellular carcinoma, which could distinguish the latter from other liver cancers. The specific features of the infiltrative growth of a bile duct tumor, such as hyperechoic infiltration along the external outlines of the ducts or hypoechoic infiltration during thickening of the duct walls, were ascertained. The sensi￾tivity of intraoperative USS in identifying intrahepatic and portal duct cholangiocarcinoma was 100%. That of USS in detecting lymph node metastases was 61%; we developed the semiotics of altered metastatic lymph nodes.

Conclusion. The findings have indicated the high informative value of ultrasound diagnosis in determining the dilatation of the bile ducts and the spread of a tumor to the liver and lymph nodes. It is recommended that the indications for intraoperative USS should be expanded in intrahepatic cholangiocellular carcinoma to define the extent of duct carcinoma.

1. Blechacz B.R., Gores G.J. Cholangiocarcinoma. Clin. Liver. Dis. 2008; 12: 131–50.

2. Friman S. Cholangiocarcinoma– current treatment options. Scand. J. Surg. 2011; 100 (1): 30–4.

3. Meza-Junco J., Montano-Loza A.J., Ma M., Wong W., Sawyer M.B., Bain V.G. Cholangiocarcinoma: has there been any progress? Can. J. Gastroenterol. 2010; 24 (1): 52–7.

4. Patel T. Cholangiocarcinoma. Nat. Clin. Pract. Gastroenterol. Hepatol. 2006; 3: 33–42.

5. Morana G., Dorigo A. Imaging of cholangiocarcinoma. Cancer. Imaging. 2011; 11 (A): S72–3.

6. Minami Y., Kudo M. Hepatic malignancies: Correlation between sonographic findings and pathological features. World J. Radiol. 2010; 2 (7): 249–56.

7. Valls C., Ruiz S., Martinez L., Leiva D. Radiological diagnosis and staging of hilar cholangiocarcinoma. World J. Gastrointest. Oncol. 2013; 5 (7): 115–26.

8. Razumilava N., Gores G.J. Classification, diagnosis, and management of cholangiocarcinoma. Clin. Gastroenterol. Hepatol. 2013; 11 (1): 13–21.

9. Tamada K., Ushio J., Sugano K. Endoscopic diagnosis of extrahepatic bile duct carcinoma: Advances and current limitations. World J. Clin. Oncol. 2011; 2 (5): 203–16.

10. Colli A., Cocciolo M., Mumoli N., Cesarini L., Prisco A., Gaffuri I., Martinez E. Peripheral intrahepatic cholangiocarcinoma: ultrasound findings and differential diagnosis from hepatocellular carcinoma. Eur. J. Ultrasound. 1998; 7: 93–9.

11. Neumaier C.E., Bertolotto M., Perrone R., Martinoli C., Loria F., Silvestri E. Staging of hilar cholangiocarcinoma with ultrasound. J. Clin. Ultrasound. 1995; 23: 173–8.

12. Xu H.X., Lu M.D., Liu G.J., Xie X.Y., Xu Z.F., Zheng Y.L., Liang J.Y. Imaging of peripheral cholangiocarcinoma with low-mechanical index contrast-enhanced sonography and SonoVue: initial experience. J. Ultrasound. Med. 2006; 25: 23–33.

13. Van Beers B.E. Diagnosis of cholangiocarcinoma. HPB (Oxford). 2008; 10 (2): 87–93.

14. Bloom C.M., Langer B., Wilson S.R. Role of US in the detection, characterization, and staging of cholangiocarcinoma. Radiographics. 1999; 19 (5): 1199–218.

15. Albu S., Tantau M., Sparchez Z., Branda H., Suteu T., Badea R., Pascu O. Diagnosis and treatment of extrahepatic cholangiocarcinoma: results in a series of 124 patients. Rom. J. Gastroenterol. 2005; 14: 33–6.

16. Watanapa P., Hargrove N.S., Sirivatanauksorn Y. The potential role of intraoperative ultrasonography in the surgical treatment of hilar cholangiocarcinoma. HPB Surg. 1996; 9 (2): 93–6.