Vnitr Lek 2016, 62(2):125-133

The rational diagnostic of cholangiocarcinoma

Martin Rydlo^1,*, Jana Dvořáčková², Tomáš Kupka¹, Pavel Klvaňa¹, Jaroslav Havelka³, Magdalena Uvírová⁴, Edvard Geryk⁵, Daniel Czerný³, Tomáš Jonszta³, Martina Bojková¹, Vladimír Hrabovský¹, Veronika Jelínková¹, Arnošt Martínek¹, Petr Dítě¹

¹ Interní klinika LF OU a FN Ostrava

² Ústav patologie LF OU a FN Ostrava

³ Ústav radiodiagnostický LF OU a FN Ostrava

⁴ CGB laboratoř, Ostrava

⁵ Oddělení pro vědu a výzkum FN Brno

Cholangiocarcinoma (CC) is a rare malignant tumour arising from cholangiocytes, and its prognosis is usually unfavourable, mostly as a result of late diagnosis of the tumour. The current incidence of cholangiocarcinoma in the Czech Republic is 1.4/100,000 inhabitants per year; in less than 30 % of patients with CC, one of the known risk factors can be identified, most frequently, primary sclerosing cholangitis. Only patients with early diagnosed and surgically amenable cholangiocarcinoma are likely to have a longer survival time; in their case, survival for more than five years has been achieved in 20 % to 40 %. From the perspective of the need for early diagnosis of CC, a significant part is played by imaging and histopathologic evaluation; the early diagnostic significance of oncomarkers is limited. The rational early diagnosis of CC consists in effective use of differentiated advantages of different imaging modalities - MRI with DSA appears to be the optimal method, endosonography is a sensitive method for the identification of malignancy in the hepatic hilum or distal common bile duct, MRCP (magnetic resonance cholangiopancreatography) is used to display pathological changes in the biliary tree, ERCP (endoscopic retrograde cholangiopancreatography) allows material removal for histopathological examination. Other new approaches are also beneficial, such as IDUS - intraductal ultrasonography of biliary tract or SPY-GLASS, enabling examination of the bile ducts by direct view with the possibility of taking targeted biopsies. Sensitivity and specificity of histology and cytology can be increased by using the molecular cytogenetic FISH method, i.e. fluorescence in situ by hybridization, with a specificity of 97 %.

Keywords: epidemiology; cholangiokarcinoma; rational diagnostic; risk factors

Received: July 29, 2015; Accepted: October 15, 2015; Published: February 1, 2016  Show citation