STAGING OF HILAR CHOLANGIOCARCINOMA WITH ULTRASOUND

The preoperative assessment of the extent of biliary and vascular invo lvement by hilar cholangiocarcinoma is clinically important because re sectability may be limited by tumor extension along the bile ducts int o the hepatic parenchyma or to the adjacent hilar vessels. Thirty-five patients with hilar cholangiocarcinoma were studied with ultrasound, and the results were compared with operative findings and other diagno stic modalities. The level of intrahepatic biliary obstruction was det ermined in 100% of patients with ductal ectasia, and a tumor mass was shown in 37.1%. Imaging and Doppler ultrasound proved accurate in dete cting the neoplastic involvement of the portal vein. Both correctly di agnosed portal occlusion and wall infiltration in 4 of 4 and 15 of 18 (83%) patients, respectively, without any false-positives. On the cont rary, imaging ultrasound had poor sensitivity in detecting infiltratio n of the hepatic artery (43%) and metastases in regional lymph nodes ( 37%), liver (66%), and peritoneum (33%). in conclusion, ultrasound may be valuable in the preoperative staging of hilar cholangiocarcinoma, specially in predicting ductal and portal involvement. (C) 1995 John W iley & Sons, Inc.