Special Topic 11: Recent Controversies in Pancreatobiliary Disease
The Korean Journal of Pancreas and Biliary Tract 2002;7(2):142-153.
간문부 담도암 수술 전 담도경 검사는 꼭 필요한가?
이상수1, 김명환1, 이성구1, 김태경2, 민영일1
1울산의대 서울아산병원 소화기내과 2울산의대 서울아산병원 방사선과
Is It Always Necessary Preoperative Percutaneous Transhepatic Cholangioscopy for the Evaluation of Longitudinal Tumor Extension in Hilar Cholangiocarcinoma?
1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 2Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author:
Myung-Hwan Kim, Tel: 82-2-3010-3180, Fax: 82-2-476-0824, Email: mhkim@www.amc.seoul.kr
ABSTRACT
Background/Aim: The utility of magnetic resonance cholangiography (MRC) in assessment of longitudinal tumor extension of hilar cholangiocarcinoma was investigated with reference to percutaneous transhepatic cholangioscopy (PTCS). Methods: A total of 99 patients with hilar cholangiocarcinoma, who underwent both MRC and PTCS examination, were studied. The longitudinal tumor extension was classified according to the Bismuth classification. Morphologic types of hilar cholangiocarcinoma were classified into stenotic type, diffuse sclerosing type, and polypoid type based on selective cholangiographic findings obtained during PTCS examination. The degree of agreement was compared between PTCS and MRC according to Bismuth classification. The degree of agreement between MRC and PTCS according to each morphologic type was also compared in the each subgroup without considering each Bismuth class. Results: The overall agreement between MRC and PTCS on Bismuth types was 87.9% (Kappa=0.832, p<0.01). The agreement of MRC in each Bismuth classification with reference to PTCS were as follows: Bismuth type I (n=18), 16/18 (88.9%); Bismuth type II (n=16), 14/16 (87.5%); Bismuth type IIIa (n=23), 19/23 (82.6%); Bismuth type IIIb (n=14), 14/14 (100%); Bismuth type IV (n=28) , 24/28 (85.7%). The overall agreement between MRC and PTCS for Bismuth class according to selective cholangiographic findings was as follows: stenotic type, 58/61 (95.1%, Kappa=0.929, p<0.01); diffuse sclerosing type, 12/16 (75%, Kappa=0.619, p<0.01); polypoid type , 17/22 (77.3%, Kappa=0.696, p<0.01). Conclusion: MRC offered good overall agreement with PTCS on longitudinal tumor extension. Especially for stenotic type of hilar cholangiocarcinoma based on selective choangiographic finding, MRC may replace the diagnostic role of PTCS in the determination of longitudinal tumor extension. For polypoid or diffuse sclerosing type of hilar cholangiocarcinoma, however, PTCS is needed for more accurate evaluation of longitudinal tumor extension.
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