Pre-operative Imaging Characteristics in Histology-Proven Resected Intrahepatic Cholangiocarcinoma
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ORIGINAL SCIENTIFIC REPORT
Pre-operative Imaging Characteristics in Histology-Proven Resected Intrahepatic Cholangiocarcinoma Nicole Cheng1,2 • Nathanelle Khoo1 • Alexander Y. F. Chung1,3 • Brian K. P. Goh1,3 Peng Chung Cheow1,3 • Pierce K. H. Chow1,3 • Ser Yee Lee1,3 • London L. Ooi1,3 • Prema Raj Jeyaraj1,3 • Juinn Huar Kam1,3 • Ye Xin Koh1 • Chung Yip Chan1,3 • Jin Yao Teo1,3
•
Accepted: 8 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the most common primary liver cancers. With the increasing incidence of ICC over the past two decades in Asia, it is essential to differentiate between HCC and ICC. However, ICC may mimic the radiological appearance of HCC on computed tomography scans (CT) and magnetic resonance imaging (MRI), leading to misdiagnosis of ICC. The objective of this study is to evaluate and describe the association of specific pre-operative imaging characteristics (arterial enhancement, portal venous washout) in patients with histologically proven resected ICC in our centre. Methods Data on patients with histology-proven ICC and mixed hepatocellular-cholangiocarcinomas (HCC-CC) who had undergone surgical resection at Singapore General Hospital (SGH) were identified from a prospectively maintained database. Pre-operative cross-sectional imaging reports were analysed. Results Ninety-one patients underwent resection between 1 January 2000 and 31 December 2016. Among those with no risk factors for HCC, a significant percentage of patients with ICC (24.3%) show imaging characteristics of both arterial phase hyperenhancement and non-peripheral venous washout. Among patients with risk factors for HCC, between 20.0 and 33.3% of patients with pure ICC fulfilled the imaging criteria for HCC, and this proportion was generally even higher in the mixed HCC-CC group. Conclusions A significant proportion of patients with pure ICC showed pre-operative imaging characteristics which fulfilled the diagnostic criteria for HCC. The differential of ICC should be borne in mind in populations where both malignancies are endemic.
Introduction
& Jin Yao Teo [email protected] 1
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
2
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
3
Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
Hepatocellular carcinoma (HCC) is the third leading cause of death in the world [1]. It is highly prevalent globally, especially in the Asia–Pacific region, with more than 70% of newly diagnosed liver cancers originating from the region annually [2]. The second most prevalent primary hepatic malignancy is intrahepatic cholangiocarcinoma (ICC) [3], representing 10–15% of all primary hepatic malignancies [4]. Due to the difficulty in obtaining an early diagnosis, only a small percentage of patients present with resectable disease (1
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