Tumor vessel: a valuable cholangioscopic clue of malignant biliary stricture

Background: An irregularly dilated and tortuous vessel, the so-called tumor vessel, is considered to be one of the cholangioscopic features that sugge st biliary malignancy. This is a prospective analysis of the presence of a tumor vessel as a finding that discriminates between benign and malignant b iliary strictures. Methods: From August 1997 to August 1998, a total of 63 patients with bilia ry strictures diagnosed with endoscopic retrograde cholangiography or percu taneous transhepatic cholangiography obtained during percutaneous transhepa tic biliary drainage tube placement were included in this study. Strictures were characterized as benign or malignant based on the observation of tumo r vessels. The results were compared with those of percutaneous transhepati c cholangiography-guided biopsy and final diagnosis. Results: Forty-one patients were confirmed to have malignant strictures and 22 had benign biliary strictures. Cancer was confirmed by histopathologic evaluation of biopsies in 33 of 41 patients with malignancy (80.4%). Tumor vessel was seen in 25 of 41 patients with malignancy (61%). No patients wit h benign stricture had tumor vessels. Of the 8 patients with negative percu taneous transhepatic cholangioscopy-guided biopsies but with a final diagno sis of malignancy, 6 had tumor vessels. Combining the observation of tumor vessel and percutaneous transhepatic cholangiography-guided biopsy resulted in a diagnosis of malignancy in 39 of 41 patients (96%) and significantly increased the rate of preoperative diagnosis when compared with percutaneou s transhepatic cholangiography-guided biopsy or presence of tumor vessel al one (p < 0.05). Conclusion: The presence of tumor vessel may be a valuable cholangioscopic finding that indicates the presence of a malignant biliary stricture. The c ombination of tumor vessel observation and percutaneous transhepatic cholan giography-guided biopsy may improve the preoperative diagnosis of malignanc y.