Danzanova T Iu, Siniukova G T, Lepédatu P I, Kudashkin N E
Vestn Rentgenol Radiol. 2014 Sep-Oct(5):26-33.
To evaluate the efficiency of ultrasound diagnosis in detecting and staging cholangiocellular carcinoma.
An ultrasound study (USS) was conducted in 120 patients aged 19 to 84 years with cholangiocellular carcinoma. The patients were divided into 3 groups by the location of a tumor process: 1) 47 (39.2%) patients with intrahepatic tumor; 2) 49 (40.8%) with portal duct or Klatskin's tumor; 3) 24 (20%) with distal one. Ninety (75%) patients were operated on; the others underwent minimally invasive X-ray surgical interventions as percutaneous transhepatic cholangiostomies. The data of ultrasound diagnosis were compared with the results of other studies, intraoperative assessment and morphological examination of a removed gross specimen.
A tumor was detectable by USS only in 90 (75%) patients; its sensitivity was 100% for intrahepatic cholangiocellular carcinoma; 69.4 and 37.5% for portal duct and distal ones, respectively. It is most difficult to diagnose distal carcinomas of the common bile duct. USS reveals no semiotic signs of intrahepatic cholangiocellular carcinoma, which could distinguish the latter from other liver cancers. The specific features of the infiltrative growth of a bile duct tumor, such as hyperechoic infiltration along the external outlines of the ducts or hypoechoic infiltration during thickening of the duct walls, were ascertained. The sensitivity of intraoperative USS in identifying intrahepatic and portal duct cholangiocarcinoma was 100%. That of USS in detecting lymph node metastases was 61%; developed the semiotics of altered metastatic lymph nodes.
The findings have indicated the high informative value of ultrasound diagnosis in determining the dilatation of the bile ducts and the spread of a tumor to the liver and lymph nodes. It is recommended that the indications for intraoperative USS should be expanded in intrahepatic cholangiocellular carcinoma to define the extent of duct carcinoma.
评估超声诊断在检测胆管细胞癌及对其进行分期方面的效能。
对120例年龄在19至84岁的胆管细胞癌患者进行了超声检查（USS）。根据肿瘤病变部位将患者分为3组：1）47例（39.2%）肝内肿瘤患者；2）49例（40.8%）肝门部胆管或肝门部肿瘤患者；3）24例（20%）远端胆管肿瘤患者。90例（75%）患者接受了手术；其余患者接受了如经皮经肝胆管造瘘术等微创X线外科干预。将超声诊断数据与其他研究结果、术中评估以及切除标本的形态学检查结果进行了比较。
仅90例（75%）患者通过USS检测到肿瘤；其对肝内胆管细胞癌的敏感性为100%；对肝门部胆管癌和远端胆管癌的敏感性分别为69.4%和37.5%。诊断胆总管远端癌最为困难。USS未发现肝内胆管细胞癌的特征性征象，无法将其与其他肝癌区分开来。确定了胆管肿瘤浸润性生长的特征，如沿胆管外部轮廓的高回声浸润或胆管壁增厚时的低回声浸润。术中USS识别肝内和肝门部胆管癌的敏感性为100%。USS检测淋巴结转移的敏感性为61%；建立了转移性淋巴结改变的征象学。
研究结果表明超声诊断在确定胆管扩张以及肿瘤向肝脏和淋巴结扩散方面具有较高的信息价值。建议在肝内胆管细胞癌中扩大术中USS的应用指征，以明确胆管癌的范围。
