Is preoperative histological diagnosis necessary before referral to major surgery for cholangiocarcinoma?
Major surgical resection is often the only curative treatment for cholangiocarcinoma. When imaging techniques fail to establish the accurate diagnosis, biopsy of the lesion is unavoidable. However, biopsy is not necessarily required for topography of the cholangiocarcinoma (intrahepatic or extrahepatic). 1) In extrahepatic cholangiocarcinoma (ECC), clinical features and radiological imaging relate to biliary obstruction. Provided that between 8% and 43% of bile duct strictures are not ECC, the lesions mimicking ECC that should be ruled out are gallbladder cancer, Mirizzi syndrome, primary sclerosing cholangitis (PSC), autoimmune pancreatitis and portal biliopathy. Systematic biopsy is usually difficult and has poor sensitivity, but a good knowledge of these mimicking ECC diseases, along with precise analysis of clinical and imaging semiology, may lead to a correct diagnosis without the need for biopsy. 2) Intrahepatic cholangiocarcinoma (ICC) developing in normal liver appears as a hypovascular tumour with fibrotic component and capsular retraction that can be confused with fibrous metastases such as breast and colorectal cancers. The lack of the primary site, a relatively large tumour size and ancillary findings such as bile duct dilatation may provide a clue to the diagnosis. If not, we advocate local resection with lymph node dissection, since ICC is the most likely diagnosis and surgery is the only curative treatment. In the event of adenocarcinoma from unknown primary, surgery is an effective treatment even if prognosis is poor.
Buc
E
E
Department of HBP Surgery, Hospital Beaujon, Clichy, France.
Lesurtel
M
M
Belghiti
J
J
Am J Gastroenterol. 2007 Aug;102(8):1781-8
17509029
Hum Pathol. 1994 Jan;25(1):86-91
8314264
Abdom Imaging. 2004 Sep-Oct;29(5):548-57
15185025
N Engl J Med. 1962 Jan 11;266:57-61
13877392
Br J Surg. 1965 Feb;52:129-39
14255983
J Hepatobiliary Pancreat Surg. 2005;12(2):159-62
15868083
Gastrointest Endosc. 1992 Jan-Feb;38(1):35-9
1612376
Gastrointest Endosc. 1994 Mar-Apr;40(2 Pt 1):150-4
8013812
J Clin Oncol. 2002 Dec 15;20(24):4679-83
12488413
Ann Surg Oncol. 2004 Mar;11(3):310-5
14993027
Gastrointest Endosc. 1996 May;43(5):498-502
8726766
Gastrointest Endosc. 1998 Sep;48(3):288-90
9744607
Ann Surg. 1978 Nov;188(5):593-7
82427
World J Surg. 2004 May;28(5):466-70
15085401
J Gastroenterol Hepatol. 2001 Oct;16(10):1086-92
11686833
Am J Gastroenterol. 2004 Aug;99(8):1464-9
15307861
Gastrointest Endosc. 1995 Dec;42(6):565-72
8674929
J Gastrointest Surg. 2002 Sep-Oct;6(5):676-81
12399056
Ann Surg. 2007 May;245(5):755-62
17457168
Dig Dis Sci. 2005 Sep;50(9):1734-40
16133981
Br J Surg. 1989 Aug;76(8):849-52
2765843
Arch Surg. 1962 Sep;85:503-13
13887615
Cancer. 1990 Apr 1;65(7):1583-90
2155699
Gastroenterology. 2004 Sep;127(3):1008-9
15362064
AJR Am J Roentgenol. 2007 Apr;188(4):W341-7
17377002
Endoscopy. 1999 Nov;31(9):712-7
10604612
Radiology. 1996 Apr;199(1):91-8
8633178
Abdom Imaging. 2002 Jan-Feb;27(1):58-60
11740610
Br J Surg. 2001 Jan;88(1):48-51
11136309
Lancet. 1999 Jul 3;354(9172):43-4
10406367
Gut. 1996 Apr;38(4):610-5
8707097
Am J Surg. 1973 Jun;125(6):782-5
4710205
Gastrointest Endosc. 2004 Dec;60(6):1021-4
15605028
Ann Radiol (Paris). 1988;31(5):309-11
3202598
Ann Intern Med. 1986 Aug;105(2):207-10
3014940
Gastrointest Endosc. 2002 Nov;56(5):720-30
12397282
Surgery. 2006 Nov;140(5):756-63
17084718
Gastrointest Endosc. 2000 Oct;52(4):534-40
11023576
Gastrointest Endosc. 2003 Aug;58(2):176-82
12872082
Gastrointest Endosc. 2006 Jan;63(1):71-7
16377319
Ann Surg Oncol. 2008 Apr;15(4):1147-54
18219538
Am J Gastroenterol. 2001 Aug;96(8):2520-2
11513216
Am J Surg. 1991 Jan;161(1):26-9; discussion 29-30
1824810
Surgery. 1999 May;125(5):514-21
10330940
Bull Cancer. 1991;78(8):725-36
1932839
N Engl J Med. 1993 Jul 22;329(4):257-63
8316270
HPB Surg. 1988 Sep;1(1):67-74; discussion 75-6
3153777
Br J Surg. 1985 Aug;72(8):659-61
4027545
Hum Pathol. 1991 Apr;22(4):387-95
2050373
Eur Radiol. 1997;7(6):865-74
9228102
Arch Pathol Lab Med. 2000 Mar;124(3):387-92
10705391
Radiographics. 2008 Jan-Feb;28(1):157-70
18203936
Hepatogastroenterology. 2007 Oct-Nov;54(79):2146-51
18251178
Hepatology. 2006 Sep;44(3):746-64
16941705
Lancet. 2005 Oct 8;366(9493):1303-14
16214602
Int Surg. 1995 Jan-Mar;80(1):61-4
7657495
Am J Surg. 1991 Jan;161(1):57-62; discussion 62-3
1846276
Am J Clin Pathol. 2005 Sep;124(3):355-60
16191503
Abdom Imaging. 1993;18(3):245-6
8508085
Am J Surg Pathol. 1988 Sep;12(9):708-15
3046396
Cancer. 2007 Aug 15;110(4):770-5
17594717
J Comput Assist Tomogr. 1983 Oct;7(5):902-4
6886144
Acta Gastroenterol Belg. 2000 Jul-Sep;63(3):254-9
11189981
Gastrointest Endosc. 2004 Sep;60(3):390-6
15332029
Am Surg. 2004 Jun;70(6):512-7
15212405
Pathol Res Pract. 1997;193(7):519-25; discussion 526
9342759
Virchows Arch. 1995;426(2):209-13
7757293
Gastrointest Endosc. 2000 Apr;51(4 Pt 1):383-90
10744806
Gut. 2002 Nov;51 Suppl 6:VI1-9
12376491
Gut. 1997 May;40(5):671-7
9203949
Hepatology. 2006 Nov;44(5):1063-74
17058222
Surgery. 1992 Nov;112(5):866-71
1332203
Gastroenterol Clin Biol. 2005 Dec;29(12):1224-32
16518276
Am J Gastroenterol. 1991 May;86(5):577-80
2028947
Hepatogastroenterology. 2007 Jul-Aug;54(77):1517-21
17708288
Abdom Imaging. 1997 Jan-Feb;22(1):87-90
9000364
Gastrointest Endosc. 1999 Nov;50(5):646-52
10536320
Eur J Surg Oncol. 2003 Oct;29(8):658-61
14511613
Semin Liver Dis. 2004 May;24(2):115-25
15192785
Clin Gastroenterol Hepatol. 2004 Mar;2(3):209-13
15017604
Radiographics. 1999 Jan-Feb;19(1):25-41; discussion 41-4
9925390
J Clin Pathol. 2001 Jun;54(6):449-55
11376018
Semin Oncol. 1993 Jun;20(3):261-7
7684858
Am J Gastroenterol. 1995 May;90(5):722-6
7733076
Ann Surg. 2005 Sep;242(3):451-8; discussion 458-61
16135931
Hepatology. 1993 May;17(5):807-13
8491448
Gastrointest Endosc. 1995 Dec;42(6):520-6
8674921
J Am Coll Surg. 2005 Dec;201(6):862-9
16310689
Mayo Clin Proc. 1993 Sep;68(9):874-9
8396700
ANZ J Surg. 2004 Oct;74(10):826
15456420