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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2022; 14(9): 536-546
Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.536
Screening for hilar biliary invasion in ampullary cancer patients
Tadayuki Takagi, Mitsuru Sugimoto, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Yuko Hashimoto, Shigeru Marubashi, Takuto Hikichi, Hiromasa Ohira
Tadayuki Takagi, Mitsuru Sugimoto, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Mika Takasumi, Takumi Yanagita, Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, Fukushima 960-1295, Japan
Jun Nakamura, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
Yuko Hashimoto, Department of Pathological Diagnosis, Fukushima Medical University, Fukushima 960-1295, Japan
Shigeru Marubashi, Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima 960-1295, Japan
Author contributions: Takagi T and Sugimoto M wrote the paper and designed and performed the study; Ohira H designed and oversaw the study; Suzuki R, Konno N, Asama H, Hikichi T, Nakamura J, Takasumi M, Sato Y, Irie H, Hashimoto M, Kato T, Kobashi R, and Yanagita T provided clinical advice; Hashimoto Y performed pathological diagnoses, and all authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Fukushima Medical University (approval number: 2453).
Informed consent statement: The patients were not required to give informed consent because this study “Screening for Hilar Biliary Invasion in Ampullary Cancer Patients” used anonymous clinical data obtained after each patient had agreed to medical activities by written consent. For full disclosure, the details of this study are published on the home page of Fukushima Medical University.
Conflict-of-interest statement: All authors declare that they have no competing interests.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mitsuru Sugimoto, MD, PhD, Assistant Professor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
kitachuuou335@yahoo.co.jp
Received: January 5, 2022
Peer-review started: January 5, 2022
First decision: June 16, 2022
Revised: June 28, 2022
Accepted: August 7, 2022
Article in press: August 7, 2022
Published online: September 16, 2022
Processing time: 252 Days and 18.5 Hours
BACKGROUND
The treatment for ampullary cancer is pancreatoduodenectomy or local ampullectomy. However, effective methods for the preoperative investigation of hilar biliary invasion in ampullary cancer patients have not yet been identified.
AIM
To determine the necessity of and an appropriate method for investigating hilar biliary invasion of ampullary cancer.
METHODS
Among 43 ampullary cancer patients, 34 underwent endoscopic treatment (n = 9) or surgery (n = 25). The use of imaging findings (thickening and enhancement of the bile duct wall on contrast-enhanced computed tomography, irregularity on endoscopic retrograde cholangiography, thickening of the entire bile duct wall on intraductal ultrasonography (IDUS), and partial thickening of the bile duct wall on IDUS) and biliary biopsy results for diagnosing hilar biliary invasion of ampullary cancer was compared.
RESULTS
Hilar invasion was not observed in every patient. Among the patients who did not undergo biliary stent insertion, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results showed the highest accuracy (100%) for diagnosing hilar biliary invasion. However, each imaging method and biliary biopsy yielded some false-positive results.
CONCLUSION
Although some false-positive results were obtained with each method, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results was useful for diagnosing hilar biliary invasion of ampullary cancer. However, hilar invasion of ampullary cancer is rare; therefore, the investigation of hilar biliary invasion of ampullary cancer might be unnecessary.
Core Tip: The standard treatment for ampullary cancer is surgical resection. However, the necessity of and appropriate diagnostic method for assessing hilar invasion is unknown. In this study, the use of contrast-enhanced computed tomography, endoscopic retrograde cholangiography, intraductal ultrasonography (IDUS), and biliary biopsy for diagnosing hilar invasion of ampullary cancer was compared. Although false positives were observed for each method, the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results was efficient for accurately diagnosing hilar invasion of ampullary cancer. On the other hand, hilar invasion of ampullary cancer is rare; thus, hilar biliary investigation might be unnecessary.
