EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: A case series

A. Fritscher-Ravens, D. C. Broering, Sreeram Parupudi, T. Topalidis, S. Jaeckle, F. Thonke, N. Soehendra

Research output: Contribution to journalArticle

136 Citations (Scopus)

Abstract

Background: Improved methods of tissue diagnosis for obstruction at the hilum of the liver (porta hepatis) have contributed substantially to the preoperative diagnosis of cholangiocarcinoma. Endoscopic brushing during endoscopic retrograde cholangiopancreatography (ERCP), with sensitivity of 20% to 100%, is the preferred technique for obtaining accurate pathologic results. Extensive hepatic resection with curative Intent as well as modern approaches to palliative treatment are based on definitive diagnosis. This is a study involving endosonography-guided, fine-needle aspiration (EUS-FNA) for cytodiagnosis of potentially operable hilar cholanglocarcinoma when brush cytology was negative or unavailable. Methods: Ten consecutive patients (7 men, 3 women; age 47 to 78 years, median 59 years) with bile duct strictures at the hepatic hilum, diagnosed by CT and/or ERCP, underwent EUS-FNA using linear echoendoscopes and 22-gauge needles. Results: Adequate material was obtained in nine patients. Cytology revealed cholangiocarcinoma in seven and hepatocellular carcinoma in one. One benign inflammatory lesion identified on cytology proved to be a false-negative finding by frozen section. Metastatic locoregional hilar lymph nodes were detected in two patients, and in one patient the celiac and para-aortic lymph nodes were aspirated to obtain tissue proof of distant metastasis. There were no complications. Conclusions: When standard methods of tissue diagnosis are inconclusive, EUS-guided FNA may have a potential role in the diagnosis of primary cholangiocarcinoma of the hepatic hilum. As a new, minimally invasive approach, it proved to be technically feasible without significant risks.

Original languageEnglish (US)
Pages (from-to)534-540
Number of pages7
JournalGastrointestinal Endoscopy
Volume52
Issue number4
StatePublished - 2000
Externally publishedYes

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Klatskin Tumor
Cytodiagnosis
Fine Needle Biopsy
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Cholangiocarcinoma
Cell Biology
Endoscopic Retrograde Cholangiopancreatography
Liver
Lymph Nodes
Endosonography
Frozen Sections
Bile Ducts
Palliative Care
Abdomen
Needles
Hepatocellular Carcinoma
Pathologic Constriction
Neoplasm Metastasis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Fritscher-Ravens, A., Broering, D. C., Parupudi, S., Topalidis, T., Jaeckle, S., Thonke, F., & Soehendra, N. (2000). EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: A case series. Gastrointestinal Endoscopy, 52(4), 534-540.

EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma : A case series. / Fritscher-Ravens, A.; Broering, D. C.; Parupudi, Sreeram; Topalidis, T.; Jaeckle, S.; Thonke, F.; Soehendra, N.

In: Gastrointestinal Endoscopy, Vol. 52, No. 4, 2000, p. 534-540.

Research output: Contribution to journalArticle

Fritscher-Ravens, A, Broering, DC, Parupudi, S, Topalidis, T, Jaeckle, S, Thonke, F & Soehendra, N 2000, 'EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: A case series', Gastrointestinal Endoscopy, vol. 52, no. 4, pp. 534-540.
Fritscher-Ravens A, Broering DC, Parupudi S, Topalidis T, Jaeckle S, Thonke F et al. EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: A case series. Gastrointestinal Endoscopy. 2000;52(4):534-540.
Fritscher-Ravens, A. ; Broering, D. C. ; Parupudi, Sreeram ; Topalidis, T. ; Jaeckle, S. ; Thonke, F. ; Soehendra, N. / EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma : A case series. In: Gastrointestinal Endoscopy. 2000 ; Vol. 52, No. 4. pp. 534-540.
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AU - Fritscher-Ravens, A.

AU - Broering, D. C.

AU - Parupudi, Sreeram

AU - Topalidis, T.

AU - Jaeckle, S.

AU - Thonke, F.

AU - Soehendra, N.

PY - 2000

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N2 - Background: Improved methods of tissue diagnosis for obstruction at the hilum of the liver (porta hepatis) have contributed substantially to the preoperative diagnosis of cholangiocarcinoma. Endoscopic brushing during endoscopic retrograde cholangiopancreatography (ERCP), with sensitivity of 20% to 100%, is the preferred technique for obtaining accurate pathologic results. Extensive hepatic resection with curative Intent as well as modern approaches to palliative treatment are based on definitive diagnosis. This is a study involving endosonography-guided, fine-needle aspiration (EUS-FNA) for cytodiagnosis of potentially operable hilar cholanglocarcinoma when brush cytology was negative or unavailable. Methods: Ten consecutive patients (7 men, 3 women; age 47 to 78 years, median 59 years) with bile duct strictures at the hepatic hilum, diagnosed by CT and/or ERCP, underwent EUS-FNA using linear echoendoscopes and 22-gauge needles. Results: Adequate material was obtained in nine patients. Cytology revealed cholangiocarcinoma in seven and hepatocellular carcinoma in one. One benign inflammatory lesion identified on cytology proved to be a false-negative finding by frozen section. Metastatic locoregional hilar lymph nodes were detected in two patients, and in one patient the celiac and para-aortic lymph nodes were aspirated to obtain tissue proof of distant metastasis. There were no complications. Conclusions: When standard methods of tissue diagnosis are inconclusive, EUS-guided FNA may have a potential role in the diagnosis of primary cholangiocarcinoma of the hepatic hilum. As a new, minimally invasive approach, it proved to be technically feasible without significant risks.

AB - Background: Improved methods of tissue diagnosis for obstruction at the hilum of the liver (porta hepatis) have contributed substantially to the preoperative diagnosis of cholangiocarcinoma. Endoscopic brushing during endoscopic retrograde cholangiopancreatography (ERCP), with sensitivity of 20% to 100%, is the preferred technique for obtaining accurate pathologic results. Extensive hepatic resection with curative Intent as well as modern approaches to palliative treatment are based on definitive diagnosis. This is a study involving endosonography-guided, fine-needle aspiration (EUS-FNA) for cytodiagnosis of potentially operable hilar cholanglocarcinoma when brush cytology was negative or unavailable. Methods: Ten consecutive patients (7 men, 3 women; age 47 to 78 years, median 59 years) with bile duct strictures at the hepatic hilum, diagnosed by CT and/or ERCP, underwent EUS-FNA using linear echoendoscopes and 22-gauge needles. Results: Adequate material was obtained in nine patients. Cytology revealed cholangiocarcinoma in seven and hepatocellular carcinoma in one. One benign inflammatory lesion identified on cytology proved to be a false-negative finding by frozen section. Metastatic locoregional hilar lymph nodes were detected in two patients, and in one patient the celiac and para-aortic lymph nodes were aspirated to obtain tissue proof of distant metastasis. There were no complications. Conclusions: When standard methods of tissue diagnosis are inconclusive, EUS-guided FNA may have a potential role in the diagnosis of primary cholangiocarcinoma of the hepatic hilum. As a new, minimally invasive approach, it proved to be technically feasible without significant risks.

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