Abstract
Hilar cholangiocarcinoma (HCCA), which lacks specific clinical manifestations, remains very difficult to distinguish from benign disease. This distinction is further complicated by the complex hilar anatomy. We conducted the present study to evaluate the differential diagnosis of these conditions. Sixty-five patients underwent resection surgery for suspected HCCA between January 2011 and October 2018. Institutional Review Board of Shengjing hospital agreed this study and all participants sign an informed consent document prior to participation in a research study. Following a postoperative pathology analysis, all patients were divided into two groups: malignant group (54 patients with HCCA) and benign group (11 cases with benign lesions). Compared with the benign group, the malignant group had a significantly higher median age and serum CA19-9, CEA, ALT, BILT and BILD levels (P < 0.05). In contrast, the groups did not differ significantly in terms of the sex distribution, clinical manifestations, serum levels of AST and ALKP, and imaging findings. In a receiver operating characteristic curve analysis, we identified a CA19-9 cutoff point of 233.15 U/ml for the differential diagnosis and CEA cutoff point of 2.98 ng/ml for the differential diagnosis. The differential diagnosis of HCCA and benign hilar lesions remains difficult. However, we found that patients with HCCA tended to have an older age at onset and higher serum levels of CA19-9, CEA, BILT, ALT and BILD. Furthermore, patients with a serum CA19-9 level >233.15 U/ml and CEA level >2.98 ng/ml are more likely to have malignant disease.
Highlights
In a receiver operating characteristic curve analysis, we identified a CA19-1 cut-off point of 233.15 U/ml for the differential diagnosis, with a sensitivity of 56% and specificity of 91%
We identified a carcinoembryonic antigen (CEA) cut-off point of 2.98 ng/ml for the differential diagnosis, with a sensitivity of 61% and specificity of 90%
We found that patients with hilar cholangiocarcinoma (HCCA) tended to have an older age at onset and higher serum levels of CA19-9, CEA, BILT, ALT, and BILD
Summary
Many conditions can lead to hilar bile duct stenosis, most cases are attributable to hilar cholangiocarcinoma (HCCA) and benign inflammation[1]. HCCA, known as Klatskin tumor, is a rare but devastating malignant disease with a poor long-term prognosis. This tumor type originates from the epithelial cells of the extrahepatic bile duct and accounts for 60–70% of all bile duct carcinomas[2,3]. The known risk factors for HCCA include chronic trematode infection, primary sclerosing cholangitis (PSC), abnormal biliary tract development, intrahepatic bile duct stones, and hepatitis B and/or hepatitis C infection[4]. Many benign hilar lesions can mimic malignancy Inflammatory lesions such as (PSC) and IgG4-associated sclerosing cholangitis (IAC) may present with the same clinical and radiological features as HCCA, including thickening of the bile duct wall, stenosis, and intrahepatic bile duct dilatation[12]. Several histopathologic studies[5,6,7,8] have noted that 14–25% of resected lesions from patients with suspected HCCA are proven to be benign
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