Clinical data and differential diagnosis of hilar cholangiocarcinoma and hilar benign diseases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Shangzhi , WANG Xin ,  KONG Jing

Department of Biliary Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, P.R.China;

Corresponding author：

KONG Jing, Email: kongjing1998@163.com

Keywords：

hilar cholangiocarcinoma; hilar benign diseases; differential diagnosis; carbohydrate antigen 19-9; carcinoembryonic antigen

DOI：

10.7507/1007-9424.201606084

Video：

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Objective To compare the clinicopathological features of hilar cholangiocarcinoma (HCCA) and hilar benign diseases, and then explore the value of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis between them. Methods Clinical data of 65 patients (54 patients with HCCA and 11 patients with hilar benign diseases) who were diagnosed as HCCA and received treatment from January 2011 to October 2015 in our hospital were retrospectively analyzed. Comparison of clinical data of HCCA patients and patients with hilar benign diseases in age, gender, disease duration, clinical manifestation, laboratory examination, and imaging examination was performed, and the receiver operating characteristic curve (ROC) was used to explore the value of CA19-9 and CEA in differential diagnosis between hilar benign diseases and HCCA. Results The age, levels of serum CA19-9, CEA, alanine aminotransferase (ALT), total bilirubin (BILT), and direct bilirubin (BILD) of HCCA group were significantly higher than that in benign group (P<0.05). However, the gender, disease duration, clinical manifestations (including jaundice, abdominal discomfort, fever, and weight loss), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALKP), and imaging findings (including hilar mass, intrahepatic bile duct dilatation, thickening of the bile duct wall, lymph node enlargement, vascular invasion, and gallbladder invasion) had no significant difference between the 2 groups (P>0.05). The ROC curve results showed that, when cut-off point for CA19-9 was 233.15 U/mL, the sensitivity was 56% and specificity was 91%; when cut-off point for CEA was 2.98 ng/mL, the sensitivity was 61% and specificity was 90%. Conclusions For the differential diagnosis between HCCA and hilar benign diseases, the elderly patients with high levels of serum transaminase and bilirubin were more likely to be malignant. It is more likely to be malignant when the serum CA19-9>233.15 U/mL or CEA>2.98 ng/mL.

Citation： HU Shangzhi, WANG Xin, KONG Jing. Clinical data and differential diagnosis of hilar cholangiocarcinoma and hilar benign diseases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(3): 343-348. doi: 10.7507/1007-9424.201606084 Copy

1.	Khalili K, Metser U, Wilson SR. Hilar biliary obstruction: preliminary results with Levovist-enhanced sonography. AJR Am J Roentgenol, 2003, 180(3): 687-693.
2.	Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med, 1965, 38(2): 241-256.
3.	Lang H, Kaiser GM, Zöpf T,et al. Surgical therapy of hilar cholangiocarcinoma. Chirurg, 2006, 77(4): 325-334.
4.	Thuluvath PJ, Rai R, Venbrux AC,et al. Cholangiocarcinoma: a review. Gastroenterologist, 1997, 5(4): 306-315.
5.	Nakayama A, Imamura H, Shimada R,et al. Proximal bile duct stricture disguised as malignant neoplasm. Surgery, 1999, 125(5): 514-521.
6.	Singh SS, Sharma R, Pal S,et al. Differentiation between benign and malignant hilar obstructions using laboratory and radiological investigations: a prospective study. HPB (Oxford), 2007, 9(5): 373-382.
7.	Knoefel WT, Prenzel KL, Peiper M,et al. Klatskin tumors and Klatskin mimicking lesions of the biliary tree. Eur J Surg Oncol, 2003, 29(8): 658-661.
8.	Binkley CE, Eckhauser FE, Colletti LM. Unusual causes of benign biliary strictures with cholangiographic features of cholangiocarcinoma. J Gastrointest Surg, 2002, 6(5): 676-681.
9.	麻勇, 许军, 代文杰. 肝门部胆管癌诊治进展. 肝胆胰外科杂志, 2005, 17(4): 343-346.
10.	Paritpokee N, Tangkijvanich P, Teerasaksilp S,et al. Fast liver alkaline phosphatase isoenzyme in diagnosis of malignant biliary obstruction. J Med Assoc Thai, 1999, 82(12): 1241-1246.
11.	黄振健, 徐建良, 蔡庆, 等. 肝门部恶性胆道梗阻的 MRI、MRCP 诊断价值. 中国 CT 和 MRI 杂志, 2012, 10(6): 73-75.
12.	赵蕊. 肝门胆管癌的超声特点分析. 中外医学研究, 2014, 8(29): 129-131.
13.	王培忠, 于丽, 周克松, 等. 超声诊断肝门胆管癌的探讨. 四川医学, 2007, 28(11): 1223-1224.
14.	Kloek JJ, van Delden OM, Erdogan D,et al. Differentiation of malignant and benign proximal bile duct strictures: the diagnostic dilemma. World J Gastroenterol, 2008, 14(32): 5032-5038.
15.	Khan SA, Davidson BR, Goldin RD,et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 2012, 61(12): 1657-1669.
16.	Reinhardt MJ, Strunk H, Gerhardt T,et al. Detection of Klatskin’s tumor in extrahepatic bile duct strictures using delayed¹⁸F-FDG PET/CT: preliminary results for 22 patient studies. J Nucl Med, 2005, 46(7): 1158-1163.
17.	La’ulu SL, Roberts WL. Performance characteristics of five automated CA 19-9 assays. Am J Clin Pathol, 2007, 127(3): 436-440.
18.	Hammarström S. The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Semin Cancer Biol, 1999, 9(2): 67-81.
19.	Juntermanns B, Radunz S, Heuer M,et al. Tumor markers as a diagnostic key for hilar cholangiocarcinoma. Eur J Med Res, 2010, 15(8): 357-361.
20.	孙文德, 曹景玉, 王云玲, 等. 多种肿瘤标志物联合检测对肝门胆管癌诊断的意义. 中国普通外科杂志, 2012, 21(2): 140-143.
21.	Erdogan D, Kloek JJ, ten Kate FJ,et al. Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures. Br J Surg, 2008, 95(6): 727-734.
22.	Oh HC, Kim MH, Lee KT,et al. Clinical clues to suspicion of IgG4-associated sclerosing cholangitis disguised as primary sclerosing cholangitis or hilar cholangiocarcinoma. J Gastroenterol Hepatol, 2010, 25(12): 1831-1837.
23.	Senda Y, Nishio H, Ebata T,et al. Hepatolithiasis in the hepatic hilum mimicking hilar cholangiocarcinoma: report of a case. Surg Today, 2011, 41(9): 1243-1246.
24.	Deng FT, Li YX, Ye L,et al. Hilar inflammatory pseudotumor mimicking hilar cholangiocarcinoma. Hepatobiliary Pancreat Dis Int, 2010, 9(2): 219-221.
25.	Hanafiah M, Alhabshi SM, Bag T,et al. Probable hepatic tuberculosis masquerading as Klatskin tumour in an immunocompetent patient. BMJ Case Rep, 2013, 2013.

1. Khalili K, Metser U, Wilson SR. Hilar biliary obstruction: preliminary results with Levovist-enhanced sonography. AJR Am J Roentgenol, 2003, 180(3): 687-693.
2. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med, 1965, 38(2): 241-256.
3. Lang H, Kaiser GM, Zöpf T,et al. Surgical therapy of hilar cholangiocarcinoma. Chirurg, 2006, 77(4): 325-334.
4. Thuluvath PJ, Rai R, Venbrux AC,et al. Cholangiocarcinoma: a review. Gastroenterologist, 1997, 5(4): 306-315.
5. Nakayama A, Imamura H, Shimada R,et al. Proximal bile duct stricture disguised as malignant neoplasm. Surgery, 1999, 125(5): 514-521.
6. Singh SS, Sharma R, Pal S,et al. Differentiation between benign and malignant hilar obstructions using laboratory and radiological investigations: a prospective study. HPB (Oxford), 2007, 9(5): 373-382.
7. Knoefel WT, Prenzel KL, Peiper M,et al. Klatskin tumors and Klatskin mimicking lesions of the biliary tree. Eur J Surg Oncol, 2003, 29(8): 658-661.
8. Binkley CE, Eckhauser FE, Colletti LM. Unusual causes of benign biliary strictures with cholangiographic features of cholangiocarcinoma. J Gastrointest Surg, 2002, 6(5): 676-681.
9. 麻勇, 许军, 代文杰. 肝门部胆管癌诊治进展. 肝胆胰外科杂志, 2005, 17(4): 343-346.
10. Paritpokee N, Tangkijvanich P, Teerasaksilp S,et al. Fast liver alkaline phosphatase isoenzyme in diagnosis of malignant biliary obstruction. J Med Assoc Thai, 1999, 82(12): 1241-1246.
11. 黄振健, 徐建良, 蔡庆, 等. 肝门部恶性胆道梗阻的 MRI、MRCP 诊断价值. 中国 CT 和 MRI 杂志, 2012, 10(6): 73-75.
12. 赵蕊. 肝门胆管癌的超声特点分析. 中外医学研究, 2014, 8(29): 129-131.
13. 王培忠, 于丽, 周克松, 等. 超声诊断肝门胆管癌的探讨. 四川医学, 2007, 28(11): 1223-1224.
14. Kloek JJ, van Delden OM, Erdogan D,et al. Differentiation of malignant and benign proximal bile duct strictures: the diagnostic dilemma. World J Gastroenterol, 2008, 14(32): 5032-5038.
15. Khan SA, Davidson BR, Goldin RD,et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut, 2012, 61(12): 1657-1669.
16. Reinhardt MJ, Strunk H, Gerhardt T,et al. Detection of Klatskin’s tumor in extrahepatic bile duct strictures using delayed¹⁸F-FDG PET/CT: preliminary results for 22 patient studies. J Nucl Med, 2005, 46(7): 1158-1163.
17. La’ulu SL, Roberts WL. Performance characteristics of five automated CA 19-9 assays. Am J Clin Pathol, 2007, 127(3): 436-440.
18. Hammarström S. The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Semin Cancer Biol, 1999, 9(2): 67-81.
19. Juntermanns B, Radunz S, Heuer M,et al. Tumor markers as a diagnostic key for hilar cholangiocarcinoma. Eur J Med Res, 2010, 15(8): 357-361.
20. 孙文德, 曹景玉, 王云玲, 等. 多种肿瘤标志物联合检测对肝门胆管癌诊断的意义. 中国普通外科杂志, 2012, 21(2): 140-143.
21. Erdogan D, Kloek JJ, ten Kate FJ,et al. Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures. Br J Surg, 2008, 95(6): 727-734.
22. Oh HC, Kim MH, Lee KT,et al. Clinical clues to suspicion of IgG4-associated sclerosing cholangitis disguised as primary sclerosing cholangitis or hilar cholangiocarcinoma. J Gastroenterol Hepatol, 2010, 25(12): 1831-1837.
23. Senda Y, Nishio H, Ebata T,et al. Hepatolithiasis in the hepatic hilum mimicking hilar cholangiocarcinoma: report of a case. Surg Today, 2011, 41(9): 1243-1246.
24. Deng FT, Li YX, Ye L,et al. Hilar inflammatory pseudotumor mimicking hilar cholangiocarcinoma. Hepatobiliary Pancreat Dis Int, 2010, 9(2): 219-221.
25. Hanafiah M, Alhabshi SM, Bag T,et al. Probable hepatic tuberculosis masquerading as Klatskin tumour in an immunocompetent patient. BMJ Case Rep, 2013, 2013.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical data and differential diagnosis of hilar cholangiocarcinoma and hilar benign diseases

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