title: Preoperative evaluation of the longitudinal extent of borderline resectable hilar cholangiocarcinoma by intraductal ultrasonography.
abstract: OBJECTIVE
  In patients with hilar cholangiocarcinoma (HC), longitudinal tumor extent is important for curative resection. The purpose of this study was to evaluate the longitudinal extents of HC using transpapillary intraductal ultrasonography (IDUS) for optimal surgical planning.
  
  
  METHODS
  From July 2006 to April 2010, a total of 42 patients with borderline resectable HC were enrolled at Samsung Medical Center, a tertiary referral hospital in Seoul, Korea. All patients were evaluated using multi-detector computed tomography (MDCT), endoscopic retrograde cholangiopancreatography (ERCP) and IDUS. The new modified Bismuth Type (MBT) classification, in which the traditional Bismuth type IV stage is divided into stages IVa and IVb, was used to determine whether the tumor invaded the left lateral section. Among the subtypes of HC, the periductal infiltrative type (PDI) and intraductal papillary neoplasm of the bile duct (IPN-B) were compared. The accuracies of CT, ERCP, and IDUS were assessed through comparison with the postoperative histology findings.
  
  
  RESULTS
  A total of 42 patients were prospectively enrolled, and the tumor extent could be assessed histologically in 30 patients. The accuracies of CT, ERCP, and IDUS were 66.6%, 60%, and 90%, respectively. The accuracy of IDUS was 85.7% in 21 patients with PDI and 100% in nine patients with IPN-B.
  
  
  CONCLUSIONS
  Hilar cholangiocarcinoma staging based on IDUS findings was highly accurate. We therefore highly recommend using IDUS for optimal surgical planning in patients with borderline resectable HC.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea.
authors.forename: E Ryoung
authors.initials: ER
authors.lastname: Choi
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Chung
authors.forename: Jong Kyun
authors.initials: JK
authors.lastname: Lee
authors.forename: Kyu Taek
authors.initials: KT
authors.lastname: Lee
authors.forename: Kwang Hyuck
authors.initials: KH
authors.lastname: Lee
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Choi
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.forename: Kee-Taek
authors.initials: KT
authors.lastname: Jang
authors.forename: Sang Mo
authors.initials: SM
authors.lastname: Park
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lim
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D057234:Preoperative Period; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000379:methods*