Abstract
Background and Study Aims: We recently reported on the contribution of intraductal ultrasonography (IDUS) to
the regional staging of bile duct cancer, and we present here the first detailed study
of the value of IDUS in assessing the portal vein invasion by bile duct cancer.
Patients and Methods: Preoperative assessment of portal vein invasion was performed by IDUS via a percutaneous
tract or via transpapillary route in 18 patients with extrahepatic bile duct cancer.
Various probes, with diameters of 1.4, 2.0, 2.4, 2.6, and 3.2 mm, and frequencies
of 7.5, 15, 20, and 30 MHz, were used. All patients additionally underwent endoscopic
ultrasonography (EUS) and angiography. In the first six cases, the IDUS and EUS images
were analyzed retrospectively without the knowledge of operative results or the other
imaging tests. In the remaning 12 cases, IDUS and EUS images were prospectively reviewed
prior to surgery, without knowledge of the angiographic findings. The gold standard
for the results of IDUS, EUS and angiography was the histopathological findings in
17 resected tumors, and the intraoperative findings in one patient who did not undergo
resective surgery.
Results: IDUS was able to demonstrate the portal vein in all cases. Its accuracy in diagnosing
portal vein invasion was 100 % for all locations. EUS was useful in assessing portal
vein invasion at the middle and distal bile duct (the accuracy was 91 %), but was
not useful in assessing invasion at the proximal bile duct (the accuracy was 57 %).
Conclusions: IDUS proved useful for assessing the extension of cancer invasion into the portal
vein, even in proximal bile duct tumors.
