Review
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 14, 2008; 14(26): 4131-4136
Published online Jul 14, 2008. doi: 10.3748/wjg.14.4131
Diagnostic approaches for cholangiocarcinoma
Andreas Weber, Roland M Schmid, Christian Prinz
Andreas Weber, Roland M Schmid, Christian Prinz, Department of Internal Medicine II, Technical University of Munich, Munich 81675, Germany
Author contributions: Weber A wrote the paper; Prinz C and Schmid RM contributed in writing and reviewing the paper.
Correspondence to: Dr. Christian Prinz, Professor, II. Medizinische Klinik, Klinikum rechts der Isar der, Technical University of Munich, Ismaninger street 22, Munich 81675, Germany. christian.prinz@lrz.tum.de
Telephone: +49-89-41405973
Fax: +49-89-41407366
Received: November 22, 2007
Revised: May 10, 2008
Accepted: May 17, 2008
Published online: July 14, 2008
Abstract

Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fine-needle aspiration. In the future, new techniques allowing for early detection, including molecular markers, should be developed to improve the diagnostic sensitivity in this increasing tumor entity.

Keywords: Diagnosis; Brush cytology; Forceps biopsy; Cholangiocarcinoma