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.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Gastrointest Surg. 2018 Sep;22(9):1528-1537. doi: 10.1007/s11605-018-3793-y. Epub 2018 May 15.
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.
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.
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.
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.
本研究旨在探讨多层螺旋 CT（MDCT）、映射活检和其他影像学方法在预测肝外胆管癌可能手术胆管边缘的纵向延伸和侵袭深度方面的诊断准确性。
2010 年 1 月至 2015 年 10 月，我们对 102 例行肝外胆管癌切除术的患者进行了评估，其中 32 例患者在胆道引流和映射活检前进行了 MDCT 检查。映射活检在 74 个部位进行，以确定胆管的切除部位（74 个可能的手术胆管边缘）。通过组织病理学评估诊断准确性。
MDCT 对纵向肿瘤扩散的诊断准确性为 79.7%，活检为 73.0%，两者结合的准确性最高（83.8%）。MDCT 上的胆管壁厚度和增强对比度可以预测肿瘤的侵袭深度，即 13 个黏膜下侵袭部位中的 11 个（84.6%），黏膜下侵袭部位的胆管壁厚度>2.5mm，增强对比度高。
MDCT 在诊断肝外胆管癌可能手术胆管边缘的纵向延伸方面具有最高的准确性。肿瘤的侵袭深度可以通过 MDCT 的胆管壁厚度和增强对比度来预测。
