Examination Of Cholangiocarcinoma

1. Laboratory tests

Serum total bilirubin, direct bilirubin, alkaline phosphatase and γ-glutamyltransferase were significantly increased. Transaminase is generally mild abnormal, this kind of bilirubin, transaminase elevation imbalance phenomenon is helpful to identify with viral hepatitis photograph. Prothrombin time was prolonged. Ca19-9 and CEA can be increased in some patients.

2. Imaging examination

Imaging examination can help to confirm the diagnosis of cholangiocarcinoma, understand the presence of metastases and evaluate the tumor's resectability.

(1) Ultrasonic imaging examination

B ultrasound examination is simple, quick, accurate and less expensive, which can find: ① dilatation of intrahepatic and extrahepatic bile ducts; ② Show the obstruction site of biliary tract; ③ The nature of obstruction. Ultrasonography is the first choice for obstructive jaundice.

Endoscopic ultrasound can avoid the interference of intestinal gas, and the frequency of ultrasound probe is high, which can show extrahepatic bile duct tumors more clearly. It has high accuracy in penetrating depth of middle and lower cholangiocarcinoma and hilar cholangiocarcinoma. It can also determine whether regional lymph nodes have metastases. Under the guidance of direct cholangiography, bile aspiration can also be performed to determine CA19-9, CEA and bile cytology. Under the guidance of ultrasound, the lesion tissue can be punctured for histological examination. Bile can also be extracted from the site of obstruction for exfoliation cell examination.

(2) Percutaneous liver puncture cholangiography (PTC)

PTC can clearly show the morphology, distribution and obstruction site of the intrahepatic and extrahepatic bile duct tree. The procedure is invasive, and postoperative bleeding and bile leakage are common and serious complications.

(3) Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP should not be used as a routine examination for cholangiocarcinoma, and even is relatively contraindicated. For high cholangiocarcinoma, percutaneous transhepatic cholangiography can show the site of the cholangiocarcinoma, and can also be placed in the support catheter to reduce yellowing. ERCP has diagnostic significance for lower segment cholangiocarcinoma, which is helpful to distinguish it from duodenal papillary tumor and pancreatic head cancer.

(4) CT examination

CT can accurately show the location and extent of bile duct dilatation and obstruction, and has a high accuracy in determining the nature of the lesion. Three-dimensional spiral CT cholangiography (SCTC) has a tendency to replace PTC and ERCP examination.

(5) Magnetic resonance cholangiopancreatography (MRCP)

MRCP examination is a non-invasive biliary imaging technique. It is an ideal imaging method for hilar cholangiocarcinoma at present, which can show the complete picture of the intrahepatic bile duct tree, the location and extent of tumor obstruction, the invasion of liver parenchyma or liver metastasis in detail.

(6) Radionuclide development scanning

Using technetium 99m EHIDA intravenously followed by continuous photography with a γ-camera, dynamic images of the biliary tract can be obtained without damage to the patient and the method is simple.

(7) Selective hepatic arteriography and portal vein angiography

The main purpose is to understand the relationship between portal vein and hepatic artery and tumor invasion, and to help evaluate the resectability of tumor before operation. Digital subtraction angiography (DSA) can show the relationship between hilar blood flow into the liver and tumor, which is of significance for extended radical resection of cholangiocarcinoma.

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