title: Is preoperative histological diagnosis necessary for cholangiocarcinoma?
abstract: Surgery is currently the only curative treatment for patients with cholangiocarcinoma (CCA). Whether histological diagnosis of CCA is necessary before surgery is controversial. Fifteen percent of patients with suspected biliary malignancy who undergo surgery are found to have benign disease. Surgery is a major procedure with significant morbidity and mortality and alternative treatment is available for those known to have benign stenoses. The aim of this review was to determine whether any of the current diagnostic tests have sufficient sensitivity and specificity to identify patients with benign and malignant bile duct stenoses. A literature search was performed until July 2007 to obtain information from studies published in the previous 10 years. Only studies reporting an appropriate reference test (confirmation of malignancy by biopsy, confirmation of benign nature by histology following surgical excision, or at least 6 months of follow-up for all patients) were included for review. The diagnostic odds ratio was used to measure diagnostic performance. Forty-one references of 34 studies were included in this review. None of the studies used differential verification. Six studies used blinding of assessor. None of the diagnostic tests had sufficient diagnostic accuracy to reliably separate patients with benign from malignant biliary strictures. Differentiating benign from malignant bile strictures is an important aim. There is no trial evidence demonstrating benefit in obtaining a preoperative histological diagnosis of CCA. New methods are required for stricture assessment.
authors.affiliation: HPB and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, UCL and Royal Free Hospital NHS Trust, London, UK. b.davidson@medsch.ucl.ac.uk
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
authors.forename: K
authors.initials: K
authors.lastname: Gurusamy
references.citation: Gastrointest Endosc. 2005 Sep;62(3):374-82
references.pmid: 16111955
references.citation: Gastrointest Endosc. 2005 Jul;62(1):85-91
references.pmid: 15990824
references.citation: Am J Gastroenterol. 2004 Jan;99(1):45-51
references.pmid: 14687140
references.citation: World J Gastroenterol. 2005 Nov 28;11(44):7024-7
references.pmid: 16437610
references.citation: Radiology. 2002 Sep;224(3):725-30
references.pmid: 12202706
references.citation: Gastrointest Endosc. 2001 Aug;54(2):162-8
references.pmid: 11474384
references.citation: BMC Bioinformatics. 2007 Jul 30;8:275
references.pmid: 17663766
references.citation: BMJ. 2001 Aug 11;323(7308):334-6
references.pmid: 11498496
references.citation: Am J Gastroenterol. 2007 Feb;102(2):269-74
references.pmid: 17100970
references.citation: Endoscopy. 1999 May;31(4):305-9
references.pmid: 10376457
references.citation: Radiology. 2005 Jul;236(1):178-83
references.pmid: 15955859
references.citation: Mayo Clin Proc. 2001 Jan;76(1):29-33
references.pmid: 11155409
references.citation: Gastrointest Endosc. 2002 May;55(6):680-6
references.pmid: 11979250
references.citation: Cancer. 2006 Aug 25;108(4):231-8
references.pmid: 16541448
references.citation: Scand J Gastroenterol. 2000 Jan;35(1):77-82
references.pmid: 10672839
references.citation: Gastrointest Endosc. 1998 Jun;47(6):479-85
references.pmid: 9647372
references.citation: Br J Surg. 2001 Jan;88(1):48-51
references.pmid: 11136309
references.citation: Hepatogastroenterology. 2007 Apr-May;54(75):664-8
references.pmid: 17591037
references.citation: Am J Gastroenterol. 1999 Jul;94(7):1941-6
references.pmid: 10406263
references.citation: J Comput Assist Tomogr. 1998 Nov-Dec;22(6):889-93
references.pmid: 9843227
references.citation: Surg Endosc. 2000 Mar;14(3):227-31
references.pmid: 10741437
references.citation: Cancer. 2003 Jun 1;97(11):2783-90
references.pmid: 12767091
references.citation: Int J Mol Med. 2001 Mar;7(3):281-7
references.pmid: 11179508
references.citation: Gastrointest Endosc. 1996 Sep;44(3):293-9
references.pmid: 8885349
references.citation: J Gastroenterol Hepatol. 2002 Mar;17(3):332-6
references.pmid: 11982705
references.citation: Eur J Gastroenterol Hepatol. 2005 Jul;17(7):733-8
references.pmid: 15947550
references.citation: J Hepatol. 2005 Aug;43(2):358-60
references.pmid: 15975687
references.citation: Tumori. 1999 May-Jun;85(3):153-6
references.pmid: 10426123
references.citation: J Gastroenterol Hepatol. 2003 Nov;18(11):1287-92
references.pmid: 14535986
references.citation: Gastrointest Endosc. 1998 May;47(5):341-9
references.pmid: 9609424
references.citation: Hepatogastroenterology. 2003 Sep-Oct;50(53):1246-9
references.pmid: 14571710
references.citation: Endoscopy. 2006 Jul;38(7):665-9
references.pmid: 16673310
references.citation: AJR Am J Roentgenol. 2001 Mar;176(3):797-802
references.pmid: 11222229
references.citation: Gastrointest Endosc. 2001 Nov;54(5):587-94
references.pmid: 11677474
references.citation: J Gastroenterol. 2005 Mar;40(3):225-35
references.pmid: 15830281
references.citation: J Vasc Interv Radiol. 2001 Dec;12(12):1437-9
references.pmid: 11742021
references.citation: Nucl Med Commun. 2001 Dec;22(12):1277-85
references.pmid: 11711897
references.citation: Endoscopy. 2002 Nov;34(11):909-16
references.pmid: 12430077
references.citation: Gut. 2002 Nov;51 Suppl 6:VI1-9
references.pmid: 12376491
references.citation: Ann Intern Med. 2001 Apr 17;134(8):657-62
references.pmid: 11304106
references.citation: Hepatology. 1998 Sep;28(3):700-6
references.pmid: 9731562
references.citation: Gut. 2002 Aug;51(2):240-4
references.pmid: 12117887
references.citation: Br J Cancer. 2006 Jun 5;94(11):1751-8
references.pmid: 16736026
references.citation: BMC Cancer. 2007 Mar 06;7:41
references.pmid: 17338829
references.citation: Gastroenterology. 2006 Oct;131(4):1064-72
references.pmid: 17030177
references.citation: Gastrointest Endosc. 2002 Nov;56(5):681-7
references.pmid: 12397276
references.citation: Hepatogastroenterology. 1998 Nov-Dec;45(24):2073-8
references.pmid: 9951868