Differential diagnosis of intrahepatic bile duct dilatation without demonstrable mass on ultrasonography or CT: benign versus malignancy.
BACKGROUND
The purpose of the present study was to define the differential diagnostic markers of benign and malignant bile duct strictures without demonstrable mass on ultrasonography (US) or computed tomography (CT) using aspects of clinical, laboratory and imaging findings.


METHODS
Between February 1995 and February 2001, 24 patients who underwent surgical resection for dilations of the bile duct (peripheral and hilar) without visible mass lesion on US or CT were included in our study. Hospital records, laboratory results, findings of imaging studies and pathological findings were reviewed retrospectively.


RESULTS
For laboratory results, levels of alkaline phosphatase (benign 163.9 +/- 145.1 vs malignant 407.25 +/- 481.7; p < 0.05) and CA 19-9 (benign 25.0 +/- 41.1 vs malignant 614.6 +/- 818.5; p < 0.05) levels were significantly elevated in the malignant group compared with that of the benign group. Findings such as thickening of the bile duct wall >/= 5 mm (P < 0.05) on radiological examination, significant regional lymph node enlargement (> 1 cm, p = 0.01) on CT scan and abrupt cut-off (P < 0.01), and separation of bile ducts (P < 0.05) on cholangiogram were differential diagnostic markers between the two groups.


CONCLUSIONS
Preoperative laboratory data such as alkaline phosphatase and CA 19-9, and imaging findings such as significant wall thickening and regional lymph node enlargement on CT, abrupt cut-off and separation of bile duct on cholangiogram are useful differential diagnostic markers for benign and malignant bile duct strictures without demonstrable mass on US or CT.
Kim
Hong Joo
HJ
Division of Gastroenterology and Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Lee
Kyu Taek
KT
Kim
Seung Hoon
SH
Lee
Jong Kyun
JK
Lim
Jae Hoon
JH
Paik
Seung Woon
SW
Rhee
Jong Chul
JC
D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology; D001662:Biliary Tract Surgical Procedures; D018395:CA-19-9 Antigen; D002758:Cholangiography; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
D018395:CA-19-9 Antigen; D000469:Alkaline Phosphatase