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Utility of contrast-enhanced harmonic endoscopic ultrasonography for T-staging of patients with extrahepatic bile duct cancer

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Abstract

Background

The value of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for T-staging in patients with extrahepatic bile duct cancer was evaluated.

Methods

This single-center, retrospective study included consecutive patients with extrahepatic bile duct cancer who underwent surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced CT (CE-CT) examinations between June 2014 and August 2017. The capacity of these modalities for T-staging of extrahepatic bile duct cancer was evaluated by assessing invasion beyond the biliary wall into the surrounding tissue, gallbladder, liver, pancreas, duodenum, portal vein system (portal vein and/or superior mesenteric vein), inferior vena cava, and hepatic arteries (proper hepatic artery, right. and/or left. hepatic artery). Blind reading of EUS, CH-EUS, and CE-CT images was performed by two expert reviewers each.

Results

38 patients were eligible for analysis, of which eight had perihilar bile duct cancer and 30 had distal bile duct cancer. Postoperative T-staging was T1 in 6, T2 in 16, and T3 in 16 cases. CH-EUS was superior to CE-CT for diagnosing invasion beyond the biliary wall into surrounding tissue (92.1% vs. 45.9%, P = 0.0002); the ability to detect invasion to other organs did not differ significantly between the two modalities. The accuracy of CH-EUS for T-staging of tumors was better than that of CE-CT (73.7% vs. 39.5%, P = 0.0059). CH-EUS tended to have a better accuracy than EUS for the diagnosis of invasion beyond the biliary wall into the surrounding tissue (92.1% vs. 78.9%, P = 0.074) and T-staging (73.7% vs. 60.5%, P = 0.074).

Conclusion

CH-EUS is useful for T-staging of extra hepatic bile duct cancer, especially in terms of invasion beyond the biliary wall into the surrounding tissue.

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Abbreviations

Ac:

Accuracy

CE-CT:

Contrast-Enhanced Computed Tomography

CH-EUS:

Contrast-Enhanced Harmonic Ultrasonography

CI:

Confidence Interval

EUS:

Endoscopic Ultrasonography

EUS-FNA:

Endoscopic Ultrasound-Guided Fine Needle Aspiration

NaN:

Not a Number

Se:

Sensitivity

Sp:

Specificity

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Funding

This work was supported by Grants-in-Aid from Japan Research Foundation for Clinical Pharmacology.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan

    Yasuo Otsuka, Ken Kamata, Akane Hara, Hidekazu Tanaka, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Tomohiro Watanabe & Masatoshi Kudo

  2. Department of Radiology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan

    Tomoko Hyodo

  3. Department of Diagnostic Pathology, Kindai University Hospital, Osaka-Sayama, Japan

    Takaaki Chikugo

  4. Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Japan

    Yasutaka Chiba

  5. Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan

    Takuya Nakai, Ippei Matsumoto & Yoshifumi Takeyama

Authors
  1. Yasuo Otsuka
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  2. Ken Kamata
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  3. Tomoko Hyodo
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  7. Tomoe Yoshikawa
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  9. Ayana Okamoto
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  21. Masatoshi Kudo
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Contributions

YO: contributed to study conception and design, performed blind reading of endosonography, and wrote the manuscript. KK: contributed to study conception and design, performed blind reading of endosonography studies, and critically revised the manuscript for important intellectual content. TH: performed radiological image evaluation. AH, HT, AO, and TY: performed data collection. KM: performed radiological image evaluation, data collection, and endosonography studies. AN and SO: performed blind reading of endosonography images and data collection. KY: performed data collection and endosonography studies. TW: critically revised the manuscript for important intellectual content. YC: performed statistical analysis of data. TC: performed pathological evaluation. TN, IM, and YT: performed surgical resection. MT and MK: critically revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Ken Kamata.

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Disclosures

Drs. Yasuo Otsuka, Ken Kamata, Tomoko Hyodo, Takaaki Chikugo, Akane Hara, Hidekazu Tanaka, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Tomohiro Watanabe, Takuya Nakai, Ippei Matsumoto, Yoshifumi Takeyama, and Masatoshi Kudo have no conflicts of interest or financial ties to disclose.

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Otsuka, Y., Kamata, K., Hyodo, T. et al. Utility of contrast-enhanced harmonic endoscopic ultrasonography for T-staging of patients with extrahepatic bile duct cancer. Surg Endosc 36, 3254–3260 (2022). https://doi.org/10.1007/s00464-021-08637-1

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  • DOI: https://doi.org/10.1007/s00464-021-08637-1

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