INTRAPORTAL ENDOVASCULAR ULTRASONOGRAPHY FOR ASSESSMENT OF VASCULAR INVASION BY BILIARY-TRACT CANCER

Background: This study was performed to investigate the diagnostic acc uracy of intraportal endovascular ultrasonography (IPEUS) in assessing vascular invasion by biliary tract cancer. Methods: A prospective stu dy of 31 consecutive patients with biliary tract cancer was performed. All patients underwent surgery. The sonographic criterion for right h epatic artery invasion was interruption of the hyperechoic layer or en casement by tumor. The sonographic criterion for portal vein invasion was obliteration of the echogenic band of the portal vein. IPEUS findi ngs were confirmed by surgical exploration and pathologic examination of resected specimens.Results: Right hepatic artery invasion was confi rmed in resected specimens in seven patients and by operative findings in four patients. Portal vein invasion was confirmed in resected spec imens in six patients and by operative findings in five patients. For diagnosis of right hepatic artery invasion, the sensitivity, specifici ty, and overall accuracy of IPEUS were all 100%; respective values wer e 63.6%, 84.2%, and 76.7% for angiography. For diagnosis of portal vei n invasion, the sensitivity, specificity, and overall accuracy of IPEU S were 100%, 95%, and 96.8%, respectively. The corresponding Values we re 63.6%, 89.5%, and 80% for portography and 54.5%, 85%, and 74.2%, re spectively, for CT. Conclusion: IPEUS will improve the assessment of v ascular invasion at the hepatic hilum by biliary tract cancer.