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Background and Aim: In hilar cholangiocarcinoma, an accurate assessment of preoperative resectability is important to optimize surgical resection. We investigated the accuracy of the combination of intraductal ultrasonography (IDUS) and percutaneous transhepatic cholangioscopy (PTCS) for evaluating longitudinal extent in hilar cholangiocarcinoma. Methods: Patients diagnosed with hilar cholangiocarcinoma underwent multidetector computed tomography (MDCT) and magnetic resonance cholangiography (MRC) for tumor staging and Bismuth type. Percutaneous transhepatic biliary drainage was performed at the left or right bile duct of the liver section that was anticipated to be preserved in the surgical treatment. After tract dilation, PTCS with cholangioscope-directed biopsy and IDUS were sequentially performed to evaluate Bismuth type. Surgical treatment was executed according to tumor staging and longitudinal tumor extent. Postoperative histological Bismuth types were compared to preoperative Bismuth types based on MDCT, MRC, PTCS with biopsy, and IDUS. Results: From June 2006 to November 2008, 25 patients with hilar cholangiocarcinoma were enrolled, with 20 of these patients evaluable. The accuracy of MDCT, MRC, PTCS with biopsy, and IDUS for the evaluation of Bismuth type was 80%, 84.2%, 90%, and 85.0%, respectively, in 20 patients, and 82.4%, 82.4%, 94.1%, and 88.2%, respectively, in 18 patients with Bismuth type IIIa, IIIb, or IV cancer. The accuracy of the combination of IDUS and PTCS with biopsy was 95% in 20 patients, and 100% in 18 with Bismuth type IIIa, IIIb, or IV cancer. Conclusions: The combination of IDUS and PTCS with biopsy was highly accurate for assessing Bismuth type and may help in the identification of an optimal surgical plan for the treatment of hilar cholangiocarcinoma, especially in Bismuth type IIIa, IIIb, or IV. [ABSTRACT FROM AUTHOR]

Background and Aim: The management of gallbladder polyps (GBP) is directly linked to the early diagnosis of gallbladder cancer (GBC). This study aimed to evaluate the malignant risk of GBP. Methods: In total, 1558 patients diagnosed with GBP were followed. Neoplastic polyps were defined as GBC and its premalignant lesions. The risk for malignancy was estimated with the cumulative detection rate of neoplastic polyps. Results: Thirty-three cases (2.1%) were diagnosed with neoplastic polyps. The cumulative detection rates of neoplastic polyps were 1.7% at 1 year, 2.8% at 5 years, and 4% at 8 years after diagnosis. The size of GBP and the presence of gallstones were risk factors for neoplastic polyps. Polyps ≥ 10 mm had a 24.2 times greater risk of malignancy than polyps < 10 mm. However, 15 of 33 neoplastic polyps (45.5%) were < 10 mm at the time of diagnosis of GBP. During follow up in 36 (3.5%) of 1027 cases, an increase in size was detected; of these, nine (25%) had neoplastic polyps. Conclusion: Even small polyps have a risk of malignancy, and careful long-term follow up of GBP will help detect and treat early GBC. [ABSTRACT FROM AUTHOR]

Background and Aim: 18F-Fluoro-2-deoxy-d-glucose positron emission tomography (18FDG-PET) is promising for diagnosis and treatment of various malignancies. The aim of this study was to evaluate the clinical usefulness of 18FDG-PET in differential diagnosis and staging of cholangiocarcinomas according to the intrahepatic, perihilar and common bile duct lesions and to compare with computerized tomography (CT) scan. Methods: From January 2000 to September 2003, 54 patients with suspected cholangiocarcinoma underwent abdominal CT scan and 18FDG-PET within a 2-week period. The PET images were analyzed visually and semiquantitatively. Results: The overall accuracy of 18FDG-PET for discriminating malignant diseases of bile duct from benign conditions was slightly higher than that of CT scan (88.9% vs 81.5%). The sensitivity of 18FDG-PET in perihilar cholangiocarcinoma was lower than the value of intrahepatic and common bile duct cancers (83.3% vs 91.3%, 90.9%); moreover, in cases of perihilar cancer, the sensitivity of 18FDG-PET was lower than that of CT scans (83.3% vs 91.7%). 18FDG-PET detected nine distant metastatic lesions not found by other imaging studies and excluded two patients who potentially had resectable condition in other imaging studies from unnecessary laparotomy. Conclusion: The clinical usefulness of 18FDG-PET in differential diagnosis of bile duct cancers is related to the site of primary disease. Although it is a helpful method for differential diagnosis especially in cases of intrahepatic and common bile duct cancers, 18FDG-PET can not provide confirmative clues in perihilar cholangiocarcinoma. 18FDG-PET may hold promise in the detection of hidden distant metastasis and can play an additional role in the evaluation of resectability. 18FDG-PET can be complementary to CT scan in diagnosing and staging of cholangiocarcinoma. [ABSTRACT FROM AUTHOR]

Background: The aim of this phase II study was to determine the efficacy of gemcitabine plus cisplatin chemotherapy in patients with advanced biliary tract cancer. Methods: Eligibility criteria included histologically confirmed adenocarcinoma with measurable tumor in the biliary tract that was unresectable and either locally advanced or metastatic. Patients received a combination of gemcitabine (1000 mg/m2 intravenously [IV] on days 1, 8, and 15) and cisplatin (75 mg/m2 IV on day 1). Cycles were repeated every 28 days. Objective tumor response rates and toxicities were evaluated according to World Health Organization criteria. Results: Twenty-seven patients were enrolled in the study and a total of 120 cycles of chemotherapy were administrated. Objective partial response was observed in nine (33.3%) patients, while stable disease was found in seven (25.9%) patients. The median survival time was 10.0 months and the 1-year survival rate was 36%. Median time to disease progression was 5.6 months. The most common grade 3–4 toxicities were leukopenia (25.9%), anemia (29.6%), thrombocytopenia (22.2%), and vomiting (18.5%). Only one patient was hospitalized for chemotherapy-related complications. Conclusion: Gemcitabine and cisplatin combination chemotherapy is an effective, safe, and well-tolerated regimen for the treatment of advanced biliary tract cancer. [ABSTRACT FROM AUTHOR]