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The Impact of MDCT and Endoscopic Transpapillary Mapping Biopsy to Predict Longitudinal Spread of Extrahepatic Cholangiocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Backgrounds

We aimed to investigate the diagnostic accuracy of multidetector-row computed tomography (MDCT), mapping biopsy, and other imaging modalities to predict the longitudinal extension and depth of invasion of extrahepatic cholangiocarcinoma at possible surgical ductal margins.

Methods

Of 102 patients with surgical resection of extrahepatic cholangiocarcinoma between January 2010 and October 2015, 32 evaluated by multidetector-row computed tomography (MDCT) performed before biliary drainage and mapping biopsy were enrolled. Mapping biopsies were performed at 74 sites to determine the resection point of the bile duct (at 74 possible surgical ductal margins). Diagnostic accuracy was evaluated by histopathology.

Results

The diagnostic accuracy of MDCT for longitudinal cancer spread was 79.7%, that of biopsy was 73.0%, and combining the two modalities showed highest accuracy (83.8%). The depth of tumor invasion could be predicted by combination of the ductal wall thickness and contrast enhancement on MDCT, that is, at 11 of 13 sites (84.6%) with submucosal invasion, ductal wall thickness was > 2.5 mm with high contrast enhancement.

Conclusions

MDCT demonstrated highest accuracy of diagnosing longitudinal extension at possible surgical ductal margins in patients with extrahepatic cholangiocarcinoma. The depth of tumor invasion could be predicted by ductal wall thickness and contrast enhancement of MDCT.

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Abbreviations

ANOVA:

Analysis of variance

Bc:

Hepatic duct confluence

Bh:

Secondary biliary branches

Bi:

Inferior bile duct

Bl:

Left hepatic duct

Bm:

Middle bile duct

Br:

Right hepatic duct

Bs:

Superior bile duct

EHBD:

Extrahepatic bile duct resection

ERC:

Endoscopic retrograde cholangiography

IDUS:

Intraductal ultrasonography

MDCT:

Multidetector-row computed tomography

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kyoji Ito, Yoshihiro Sakamoto, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita & Kiyoshi Hasegawa

  2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hiroyuki Isayama & Yosuke Nakai

  3. Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takeyuki Watadani

  4. Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Mariko Tanaka & Tetsuo Ushiku

  5. National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Norihiro Kokudo

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  1. Kyoji Ito
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Contributions

(1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work.

Conception or design of the work: Kyoji Ito and Yoshihiro Sakamoto.

Acquisition of data: Yoshihiro Sakamoto, Hiroyuki Isayama, Yosuke Nakai, Takeyuki Watadani, Mariko Tanaka, Tetsuo Ushiku, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita, Kiyoshi Hasegawa, and Norihiro Kokudo.

Interpretation of data for the work: Kyoji Ito and Yoshihiro Sakamoto.

(2) Drafting the work or revising it critically for important intellectual content.

Drafting the work: Kyoji Ito and Yoshihiro Sakamoto.

Revising the work critically for important intellectual content: Hiroyuki Isayama, Yosuke Nakai, Takeyuki Watadani, Mariko Tanaka, Tetsuo Ushiku, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita, Kiyoshi Hasegawa, and Norihiro Kokudo.

3) Final approval of the version to be published.

All authors.

4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

All authors.

Corresponding authors

Correspondence to Yoshihiro Sakamoto or Norihiro Kokudo.

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Ito, K., Sakamoto, Y., Isayama, H. et al. The Impact of MDCT and Endoscopic Transpapillary Mapping Biopsy to Predict Longitudinal Spread of Extrahepatic Cholangiocarcinoma. J Gastrointest Surg 22, 1528–1537 (2018). https://doi.org/10.1007/s11605-018-3793-y

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  • DOI: https://doi.org/10.1007/s11605-018-3793-y

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