Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience.
BACKGROUND
Accurate preoperative diagnosis and staging of cholangiocarcinoma (CCA) remain difficult.


OBJECTIVE
To evaluate the utility of EUS in the diagnosis and preoperative evaluation of CCA.


METHODS
Observational study of prospectively collected data.


METHODS
Single tertiary referral hospital in Indianapolis, Indiana.


METHODS
Consecutive patients with CCA from January 2003 through October 2009.


METHODS
EUS and EUS-guided FNA (EUS-FNA).


METHODS
Sensitivity of EUS for the detection of a tumor and prediction of unresectability compared with CT and magnetic resonance imaging (MRI); sensitivity of EUS-FNA to provide tissue diagnosis, by using surgical pathology as a reference standard.


RESULTS
A total of 228 patients with biliary strictures undergoing EUS were identified. Of these, 81 (mean age 70 years, 45 men) had CCA. Fifty-one patients (63%) had distal and 30 (37%) had proximal CCA. For those with available imaging, tumor detection was superior with EUS compared with triphasic CT (76 of 81 [94%] vs 23 of 75 [30%], respectively; P < .001). MRI identified the tumor in 11 of 26 patients (42%; P = .07 vs EUS). EUS identified CCA in all 51 (100%) distal and 25 (83%) of 30 proximal tumors (P < .01). EUS-FNA (median, 5 passes; range, 1-12 passes) was performed in 74 patients (91%). The overall sensitivity of EUS-FNA for the diagnosis of CCA was 73% (95% confidence interval, 62%-82%) and was significantly higher in distal compared with proximal CCA (81% vs 59%, respectively; P = .04). Fifteen tumors were definitely unresectable. EUS correctly identified unresectability in 8 of 15 and correctly identified the 38 of 39 patients with resectable tumors (53% sensitivity and 97% specificity for unresectability). CT and/or MRI failed to detect unresectability in 6 of these 8 patients.


CONCLUSIONS
Single-center study.


CONCLUSIONS
EUS and EUS-FNA are sensitive for the diagnosis of CCA and very specific in predicting unresectability. The sensitivity of EUS-FNA is significantly higher in distal than in proximal CCA.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Mehdi
M
Mohamadnejad
John M
JM
DeWitt
Stuart
S
Sherman
Julia K
JK
LeBlanc
Henry A
HA
Pitt
Michael G
MG
House
Kelly J
KJ
Jones
Evan L
EL
Fogel
Lee
L
McHenry
James L
JL
Watkins
Gregory A
GA
Cote
Glen A
GA
Lehman
Mohammad A
MA
Al-Haddad
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology; D044963:Biopsy, Fine-Needle; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed