Preoperative evaluation of Klatskin tumor: accuracy of spiral CT in determining vascular invasion as a sign of unresectability

Background: To assess the accuracy of spiral computed tomoraphy (CT) in pre dicting the resectability of Klatskin tumor as determined by vascular invas ion. Methods: Twenty-one consecutive patients with Klatskin tumor who had underg one laparotomy were included in this study. The preoperative thin-section ( 5-mm-thick) spiral CT scans of these patients wen assessed for the surgical resectability of tumor by evaluating the vascular invasion. The criterion for vascular invasion indicating unresectability was the tumoral invasion o f the proper hepatic artery or main portal vein or simultaneous invasion of one side of the hepatic artery and the other side of the portal vein. Results: All nine patients with tumors thought to be unresectable on the ba sis of CT findings had tumors that were unresectable at surgery (positive p redictive value, 100%). Of 12 patients with tumors thought to be resectable , six had resectable tumors (negative predictive value, 50%). Spiral CT fai led to detect small hepatic metastasis (n = 1), lymph node metastasis (n = 1), extensive tumor (n = 2) and variation of bile duct (n = 2), which precl uded surgical resection. Conclusion: Spiral CT is a reliable method for detecting vascular invasion and unresectable tumors. However, it has limitations in detecting variation s of the bile duct or the intraductal extent of tumor.