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DOI: 10.1055/a-2005-3679
Endoscopic ultrasound in patients with resectable perihilar cholangiocarcinoma: impact on clinical decision-making
Abstract
Background and study aims Accurate assessment of the lymph node (LN) status is crucial in resectable perihilar cholangiocarcinoma (pCCA) to prevent major surgery in patients with extraregional metastatic LNs (MLNs). This study investigates the added value of preoperative endoscopic ultrasound (EUS) with or without tissue acquisition (TA) for the detection of MLNs in patients with resectable pCCA.
Patients and methods In this retrospective, multicenter cohort study, patients with potentially resectable pCCA who underwent EUS preoperatively between 2010–2020, were included. The clinical impact of EUS-TA was defined as the percentage of patients who did not undergo surgical resection due to MLNs found with EUS-TA. Findings of cross-sectional imaging were compared with EUS-TA findings and surgery.
Results EUS was performed on 141 patients, of whom 107 (76 %) had suspicious LNs on cross-sectional imaging. Surgical exploration was prevented in 20 patients (14 %) because EUS-TA detected MLNs, of which 17 (85 %) were extraregional. Finally, 74 patients (52 %) underwent surgical exploration followed by complete resection in 40 (28 %). MLNs were identified at definitive pathology in 24 (33 %) patients, of which 9 (38 %) were extraregional and 15 (63 %) regional.
Conclusions EUS-TA may be of value in patients with potentially resectable pCCA based on preoperative cross-sectional imaging, regardless of lymphadenopathy at cross-sectional imaging. A prospective study in which a comprehensive EUS investigation with LN assessment and EUS-TA of LNs is performed routinely should confirm this promise.
Publication History
Received: 26 July 2022
Accepted after revision: 03 November 2022
Accepted Manuscript online:
30 December 2022
Article published online:
02 February 2023
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Blechacz B, Komuta M, Roskams T. et al. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2011; 8: 512-522
- 2 Blechacz B. Cholangiocarcinoma: Current knowledge and new developments. Gut Liver 2017; 11: 13-26
- 3 Radtke A, Konigsrainer A. Surgical therapy of cholangiocarcinoma. Visc Med 2016; 32: 422-426
- 4 Khan SA, Davidson BR, Goldin RD. et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut 2012; 61: 1657-1669
- 5 Banales JM, Cardinale V, Carpino G. et al. Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenterol Hepatol 2016; 13: 261-280
- 6 Cillo U, Fondevila C, Donadon M. et al. Surgery for cholangiocarcinoma. Liver Int 2019; 39: 143-155
- 7 Amin MB, Gress DM, Meyer VegaLR. et al. AJCC Cancer Staging Manual, Eighth Edition. New York: Springer International Publishing; 2017: 295-301
- 8 Edge SB, Compton CC, Fritz AG. et al. Trotti. American joint committee on cancer: Cancer staging manual, 7 ed. New York: Springer International Publishing; 2010: 201-234
- 9 Gaspersz MP, Buettner S, van Vugt JLA. et al. Evaluation of the new american joint committee on cancer staging manual 8th edition for perihilar cholangiocarcinoma. J Gastrointest Surg 2020; 24: 1612-1618
- 10 Cai Y, Cheng N, Ye H. et al. The current management of cholangiocarcinoma: A comparison of current guidelines. Biosci Trends 2016; 10: 92-102
- 11 [Anonymous]. Galweg- en galblaascarcinoom, landelijke richtlijn [Internet]. Integraal Kankercentrum Nederland; c2003–2013. Available from (Accessed June 1 2022) https://richtlijnendatabase.nl/richtlijn/galweg_en_galblaascarcinoom/algemeen.html
- 12 Ruys AT, van Beem BE, Engelbrecht MR. et al. Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol 2012; 85: 1255-1262
- 13 Hanninen EL, Pech M, Jonas S. et al. Magnetic resonance imaging including magnetic resonance cholangiopancreatography for tumor localization and therapy planning in malignant hilar obstructions. Acta Radiol 2005; 46: 462-470
- 14 Malikowski T, Levy MJ, Gleeson FC. et al. Endoscopic ultrasound/fine needle aspiration is effective for lymph node staging in patients with cholangiocarcinoma. Hepatology 2020; 72: 940-948
- 15 Gleeson FC, Rajan E, Levy MJ. et al. EUS-guided FNA of regional lymph nodes in patients with unresectable hilar cholangiocarcinoma. Gastrointest Endosc 2008; 67: 438-443
- 16 Mohamadnejad M, DeWitt JM, Sherman S. et al. Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc 2011; 73: 71-78
- 17 Liang L, Li C, Jia HD. et al. Prognostic factors of resectable perihilar cholangiocarcinoma: a systematic review and meta-analysis of high-quality studies. Ther Adv Gastrointest Endosc 2021; 14 DOI: 10.1177/2631774521993065.
- 18 Furukawa H, Ikuma H, Asakura-Yokoe K. et al. Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology. Eur Radiol 2008; 18: 2841-284719
- 19 Loch FN, Asbach P, Haas M. et al. Accuracy of various criteria for lymph node staging in ductal adenocarcinoma of the pancreatic head by computed tomography and magnetic resonance imaging. World J Surg Oncol 2020; 18: 213
- 20 Zhuang Z, Zhang Y, Wei M. et al. Magnetic resonance imaging evaluation of the accuracy of various lymph node staging criteria in rectal cancer: a systematic review and meta-analysis. Frontier Oncology 2021; 11 DOI: 10.3389/fonc.2021.709070.