PURPOSE: To retrospectively assess the accuracy of combined multiphasic computed tomography (CT) and direct cholangiography for evaluation of the resectability of hilar cholangiocarcinoma, on the basis of revised criteria for unresect-ability, by using surgery as the reference standard.
MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. From 1998 to 2003, 55 patients (37 men, 18 women; mean age � standard deviation, 59 years �12) with surgically proved hilar cholangio-carcinomas who underwent preoperative CT (single-detector row CT, n = 26; multi-detector row CT, n = 29) and cholangiography were included for study. The authors revised criteria for unresectable tumor were contralateral hepatic artery invasion; main or contralateral porta) vein invasion longer than 2 cm; biliary extension to the contralateral secondary confluence, farther than 2 cm from hepatic hilum; enlarged lymph nodes at the celiac, portacaval, and paraaortic area; and other ancillary findings. Tumor resectability based on these parameters was determined at imaging by two radiologists in consensus. Mann-Whitney U test and weighted k coefficient of agreement were used for accuracy determination.
RESULTS: For depiction of portal vein invasion (in 26 patients), CT yielded an accuracy of 85.5%. Arterial invasion was found at surgery in 19 patients, with CT providing an accuracy of 92.7%. For prediction of node involvement (15 patients, 27%), CT yielded an accuracy of 83.6%. The extent of ductal involvement could be accurately predicted in 46 patients (84%) (weighted k = 0.767). In 30 of 42 patients with disease classified as resectable according to revised criteria, disease was found to be resectable at surgery (71.4% positive predictive value). In 11 of 13 patients with disease classified as unresectable according to revised criteria, unresectable disease was confirmed (84.6% negative predictive value). Overall accuracy of resectability was 74.5%.
CONCLUSION: Combined interpretation of CT and direct cholangio-graphic images by using our revised criteria resulted in overall accuracy of 74.5% for prediction of resectability for hilar cholangiocarcinoma.