The Role of Endoscopic ultrasound in Tumour staging and Tissue diagnosis of Hilar strictures/Hilar cholangiocarcinomas – Prospective observational study

Aims The aim of this study is to compare the role of endoscopic ultrasound (EUS) in tumor staging, particularly nodal staging, to cross-sectional imaging, and tissue diagnosis in Hilar cholangiocarcinoma to ERCP-brush cytology [1] [2].

Methods This is a prospective observational study done in a single tertiary care hospital from November 2019 to August 2021 and included patients who underwent EUS in obstructive jaundice due to hilar cholangiocarcinoma after being diagnosed on cross-sectional imaging and were followed for 6 months

Results A total of 54 patients were enrolled in this study and the mean age of 55 years with BMI-24.3 kg/m2 of which 75.9% were males. Overall, EUS detected Lymph nodes in 38 patients (70.3%) whereas CECT/MRCP lymph nodes were detected in only 21 patients (38.9%) and EUS has detected significantly more lymph nodes when compared to CECT/MRCP (p-0.002) and was more accurate in regional Nodal staging. patients were categorized as N0 staging in 33 patients (61.1%) on CECT/MRCP, while in 16 patients (29.6%) on EUS, N1 staging in 16 patients (29.6%) while 30 patients(55.6%) on EUS and N2 staging in 5 patients (9.3%) on CECT/MRCP and 8 patients (14.8%) on EUS. In 54 patients, EUS -FNA was done in 40 patients and not done in 14 patients and ERCP brush cytology was taken in 47 patients. Overall, EUS has diagnosed more malignancy in 24 patients (60%) when compared to ERCP brush cytology only in 13 patients (27.7%) (p-0.002).EUS-FNA detected malignancy in approximately 44.1% of patients with Negative ERCP Brush cytology. After 6 months of follow-up, overall survival was observed in 25 patients (46.3%), 9 patients (16.7%) had lost follow-up, and 20 patients died (30%) with mean days from diagnosis of 51.2 days

Conclusions Endoscopic ultrasound has a more significant and superior role in regional nodal staging than cross-sectional imaging and ERCP-brush cytology.

Publication History

Article published online:
27 March 2025

• References

• 1 Navaneethan U, Njei B. Endoscopic ultrasound in the diagnosis of cholangiocarcinoma as the etiology of biliary strictures: a systematic review and meta-analysis. Gastroenterology Report 2015; 3: 209-215
• 2 Malikowski T, Levy MJ, Gleeson FC, Chandrasekhara V.. Endoscopic Ultrasound/Fine Needle Aspiration Is Effective for Lymph Node Staging in Patients With Cholangiocarcinoma. Hepatology 2020; 72 (3): 940-948