title: Endoscopic biliary imaging and clinicopathological features of cystic duct cancer.
abstract: BACKGROUND
  Cystic duct cancer fulfilling Farrar's criteria is relatively rare, but tumors whose origin is estimated to be in the cystic duct exist. The clinical features of such "broadly defined" cystic duct cancer have not been clarified.
  
  
  METHODS
  The endoscopic retrograde cholangiography (ERC) findings, intraductal ultrasonography (IDUS) findings, histological findings, and prognoses of 11 cases of cystic duct cancers resected at our institution (group C) were retrospectively analyzed. As a control group, 55 cases of middle or lower bile duct cancer (group B) were used (in 20 of the 55 cases of group B, tumors extended to the cystic duct intraluminally (group B-C (+)).
  
  
  RESULTS
  (1) ERC findings of group C as compared with those of group B-C (+) were as follows: (a) unilateral bile duct narrowing (spoon-like appearance): 55% versus 5% (P<0.01); (b) bilateral bile duct narrowing (apple-core-like appearance): 27% versus 95% (P<0.001). (2) IDUS was unable to visualize the cysticocholedochal junction (negative "confluence sign") more often in group C (67%) than in group B-C (+) (13%) (P<0.01). (3) Histologically, tumors extended to the gallbladder and the bile duct in 36% and 91% of the cases in group C, respectively. (4) The median survival time of the two groups was 21 and 28 months, respectively.
  
  
  CONCLUSIONS
  Cystic duct cancers frequently extended to the bile duct. The spoon-like appearance by ERC and the negative confluence sign by IDUS were characteristic findings.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino, Sendai, 983-0824, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Obana
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Noda
authors.forename: Go
authors.initials: G
authors.lastname: Kobayashi
authors.forename: Kei
authors.initials: K
authors.lastname: Ito
authors.forename: Toshiki
authors.initials: T
authors.lastname: Sugawara
authors.forename: Jun
authors.initials: J
authors.lastname: Horaguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Takasawa
authors.forename: Takuro
authors.initials: T
authors.lastname: Endo
authors.forename: Kazunari
authors.initials: K
authors.lastname: Nakahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Sawai
authors.forename: Miwa
authors.initials: M
authors.lastname: Uzuki
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000473:pathology; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003549:Cystic Duct / Q000000981:diagnostic imaging / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018084:Ultrasonography, Interventional