Ito Yasuhiro, Shibutani Shintaro, Egawa Tomohisa, Hayashi Shinobu, Nagashima Atsushi, Kitagawa Yuko
Hepatogastroenterology. 2015 Jun;62(140):782-6.
BACKGROUND/AIMS: It is difficult to diagnose cholangiocarcinoma in the early stages because most patients present with jaundice, which is generally thought to be the most important symptom at diagnosis. Despite improvements to surgical instruments and techniques, these rates are not quite satisfactory. Intraductal ultrasound (IDUS) is easy to handle due to the wire-guided, thin-caliber, and high-frequency probe. The purpose of the present study was to assess the efficacy of IDUS as a diagnostic tool for patients with early distal cholangiocarcinoma.
We enrolled 23 with early distal cholangiocarcinoma. The cholangiography and IDUS findings were retrospectively analyzed. The morphology of the tumors detected by IDUS was also classified including localized wall thickening, polypoid lesion, and sessile tumor.
The morphologies on IDUS were as follows: five (21.7%) localized wall thickenings, five (21.7%) polypoid lesions, and 13 (56.5%) sessile tumors.
Since forceps biopsy complemented by IDUS can substantially improve the diagnostic rate, pathological investigations should be performed simultaneously after detection by IDUS. We believe that noninvasive modalities should be followed by IDUS and used as a decisive approach to distinguish between benign and malignant status.
背景/目的：胆管癌早期诊断困难，因为大多数患者出现黄疸，一般认为这是诊断时最重要的症状。尽管手术器械和技术有所改进，但这些比率仍不尽人意。由于采用导丝引导、细口径和高频探头，导管内超声（IDUS）易于操作。本研究的目的是评估IDUS作为早期远端胆管癌患者诊断工具的有效性。
我们纳入了23例早期远端胆管癌患者。对胆管造影和IDUS检查结果进行回顾性分析。IDUS检测到的肿瘤形态也进行了分类，包括局限性壁增厚、息肉样病变和无蒂肿瘤。
IDUS显示的形态如下：5例（21.7%）局限性壁增厚，5例（21.7%）息肉样病变，13例（56.5%）无蒂肿瘤。
由于IDUS辅助钳取活检可显著提高诊断率，因此在IDUS检测后应同时进行病理检查。我们认为，在采用非侵入性检查方法后应进行IDUS检查，并将其作为区分良性和恶性状态的决定性方法。
