Abstract
Cholangiocarcinoma is a malignancy arising from the epithelial lining of the intrahepatic or extrahepatic biliary tract. Timely diagnosis is challenging due to its silent clinical course. As reliable laboratory markers are lacking, diagnostic imaging plays a pivotal role. While cross-sectional imaging studies are usually conclusive for intrahepatic lesions, endoscopy plays an essential role in cases of extrahepatic tumors. Rational utilization of different diagnostic methods based on available evidence is needed. This article focuses on the diagnostic role of advanced biliary endoscopy, including endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic ultrasonography, and intraductal sonography.
Highlights
A timely diagnosis of cholangiocarcinoma remains challenging due to its silent clinical course
Making a diagnosis of ECCA in a nonjaundiced person remains a crucial issue. It has been shown by Sugiyama et al that abnormalities in hepatic function and tumor marker tests combined with transabdominal ultrasonography (US) can be used for early diagnosis of ECCA in patients without jaundice, with resulting resectability of 83% and survival of 50% at 5 years [11]
Endoscopic ultrasound (EUS)-fine needle aspiration (FNA) sensitivity and specificity for differentiating ECCA from benign biliary lesions range between 43-89% and 79-100%, respectively
Summary
A timely diagnosis of cholangiocarcinoma remains challenging due to its silent clinical course. As reliable laboratory markers are lacking, diagnostic imaging plays a pivotal role. While cross-sectional imaging studies are usually conclusive for intrahepatic lesions, endoscopy plays an essential role in cases of extrahepatic tumors. Tissue specimen is usually necessary in both locations. This article addresses cholangiocarcinoma from the perspective of endoscopic imaging and tissue sampling
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