Fritscher-Ravens, A.; Swain, P.; Rogiers, X.; Topalidis, T.; Thonke, F.; Soehendra, N.; Broering, D.C.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA4
Academic Journal
Background: Despite improvements of diagnostic modalities differentiation between benign and malignant strictures at the liver hilum remains a challenge. Extensive hepatic resections with intention to cure or modern palliative concepts require preoperative diagnosis, to avoid risk of misdiagnosis and inappropriate surgical treatment for the patients. Preoperative tissue diagnosis, most commonly achieved during ERCP, can be difficult. We used endosonography guided fine needie aspiration (EUS-FNA) for preoperative diagnosis of hilar cholangiocarcinoma. Methods: Prospective evaluation of 44 patients (31 male, age 37-74, mean age 59) with strictures at the liver hilum diagnosed by computed tomography and/or ERCP. All were highly suspicious of hilar cholangiocarcinoma but had inconclusive brush cytology or biopsy, and subsequently underwent EUS-FNA with a linear echoendoscope and 22 gauge needles. Results: Adequate material was achieved in 43 out of 44 patients. Cytology revealed chloangiocarcinoma in 26 patients, hepatocellular carcinoma, Hodgkin's disease, metastasis of colon and ovarian cancer, and neuroendocrine tumour in one each. Twelve patients had benign diseases with chronic fibrosing inflammation in four, inflammation in two, sarcoid like changes in one and primary sclerosing cholangitis (PSC) in five. Four of the benign results were false negatives. Thirty five patients underwent surgery. Patients with benign results and PSC were followed up, patients with Hodgkin's disease and metastases of other primaries had chemotherapy. In one patient adenocarcinoma was discovered at repeat surgery. No complication occurred. Accuracy, sensitivity, and specificity were 91%, 90%, and 100%, respectively. EUS and EUS-FNA changed preplanned surgical approach in 22/43 patients. Conclusion: These results suggest that EUS-FNA may be a valuable, less invasive approach for tissue diagnosis of unknown hilar strictures. It proved to be technically feasible without significant...


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