Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 1/2021

01-01-2021 | Cholangiocarcinoma | Original Article

New method for the assessment of perineural invasion from perihilar cholangiocarcinoma

Authors: Hiroshi Tanaka, Tsuyoshi Igami, Yoshie Shimoyama, Tomoki Ebata, Yukihiro Yokoyama, Kensaku Mori, Masato Nagino

Published in: Surgery Today | Issue 1/2021

Login to get access

Abstract

Purpose

Perineural invasion (PN) is often found in perihilar cholangiocarcinoma. New procedure was developed to assess PN around the right hepatic artery (RHA) using dual-energy computed tomography (DECT).

Methods

Thirty patients with perihilar cholangiocarcinoma who underwent DECT before biliary drainage were retrospectively reviewed. Mask images, i.e., the periarterial layer (PAL) around the RHA and superior mesenteric artery (SMA), were made from late arterial phase DECT. The mean CT number of the PAL was measured.

Results

Twenty patients with PN around the RHA were classified into the PN (+) group. The remaining 10 patients without PN and other 26 patients with other diseases that are never accompanied with PN were classified into the PN (−) group. The PAL ratio (the CT number of the PAL around the RHA relative to that around the SMA) was calculated. Both the mean CT number of the PAL around the RHA and the PAL ratio were significantly higher in the PN (+) group than in the PN (−) group. According to an ROC analysis, the predictive ability of the PAL ratio was superior. Using the cutoff value of the PAL ratio 1.009, a diagnosis of PN around the RHA was made with approximately 75% accuracy.

Conclusions

Assessment with CT number of the PAL reconstructed from DECT images is an easy and objective method to diagnose PN.
Literature
1.
Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg. 2013;258:129–40.PubMedCrossRef
2.
Abbas S, Sandroussi C. Systematic review and meta-analysis of the role of vascular resection in the treatment of hilar cholangiocarcinoma. HPB (Oxford). 2013;15(7):492–503.CrossRef
3.
Nagino M. Perihilar cholangiocarcinoma: a surgeon's viewpoint on current topics. J Gastroenterol. 2012;47(11):1165–76.PubMedCrossRef
4.
Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg. 2010;252(1):115–23.PubMedCrossRef
5.
Nimura Y. Radical surgery: vascular and pancreatic resection for cholangiocarcinoma. HPB (Oxford). 2008;10(3):183–5.CrossRef
6.
Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238(5):720–7.PubMedPubMedCentralCrossRef
7.
Fukami Y, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, et al. Diagnostic ability of MDCT to assess right hepatic artery invasion by perihilar cholangiocarcinoma with left-sided predominance. J Hepatobiliary Pancreat Sci. 2012;19(2):179–86.PubMedCrossRef
8.
Sugiura T, Nishio H, Nagino M, Senda Y, Ebata T, Yokoyama Y, et al. Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg. 2008;32(7):1478–84.PubMedCrossRef
9.
Johonson TRC, Fink C, Schonberg SO, Reiser MF, editors. Dual energy CT in clinical practice. Heidelberg: Springer; 2011.
10.
Thaiss WM, Sauter AW, Bongers M, Horger M, Nikolaou K. Clinical applications for dual energy CT versus dynamic contrast enhanced CT in oncology. Eur J Radiol. 2015;84(12):2368–79.PubMedCrossRef
11.
Paul J, Vogl TJ, Mbalisike EC. Oncological applications of dual-energy computed tomography imaging. J Comput Assist Tomogr. 2014;38(6):834–42.PubMedCrossRef
12.
Simons D, Kachelriess M, Schlemmer HP. Recent developments of dual-energy CT in oncology. Eur Radiol. 2014;24(4):930–9.PubMedCrossRef
13.
International Union Against Cancer (UICC). TNM classification of malignant tumors. 7th ed. New York: Wiley-Liss; 2009.
14.
15.
Nimura Y, Deguchi D, Kitasaka T, Mori K, Suenaga Y. PLUTO: a common platform for computer-aided diagnosis. Med Imaging Technol. 2008;26:187–91 (in Japanese).
16.
Takahashi H, Mori M. Characteristics and significance of criteria for obesity disease in Japan 2011. Nihon Rinsho. 2013;71(2):257–61 (in Japanese).PubMed
17.
Murakami Y, Uemura K, Sudo T, Hashimoto Y, Kondo N, Nakagawa N, et al. Perineural invasion in extrahepatic cholangiocarcinoma: prognostic impact and treatment strategies. J Gastrointest Surg. 2013;17(8):1429–39.PubMedCrossRef
18.
Kondo S, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, et al. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg. 2008;15(1):41–544.PubMedPubMedCentralCrossRef
19.
Shirai K, Ebata T, Oda K, Nishio H, Nagasaka T, Nimura Y, et al. Perineural invasion is a prognostic factor in intrahepatic cholangiocarcinoma. World J Surg. 2008;32(11):2395–402.PubMedCrossRef
20.
Yamaguchi R, Nagino M, Oda K, Kamiya J, Uesaka K, Nimura Y. Perineural invasion has a negative impact on survival of patients with gallbladder carcinoma. Br J Surg. 2002;89(9):1130–6.PubMedCrossRef
21.
Schorn S, Demir IE, Haller B, Scheufele F, Reyes CM, Tieftrunk E, et al. The influence of neural invasion on survival and tumor recurrence in pancreatic ductal adenocarcinoma—a systematic review and meta-analysis. Surg Oncol. 2017;26(1):105–15.PubMedCrossRef
22.
Mochizuki K, Gabata T, Kozaka K, Hattori Y, Zen Y, Kitagawa H, et al. MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: correlation with en bloc pathological specimens and diagnostic accuracy. Eur Radiol. 2010;20(7):1757–67.PubMedCrossRef
23.
Zuo HD, Zhang XM, Li CJ, Cai CP, Zhao QH, Xie XG, et al. CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part I): anatomy, imaging of the extrapancreatic nerve. World J Radiol. 2012;4(2):36–433.PubMedPubMedCentralCrossRef
24.
Zuo HD, Tang W, Zhang XM, Zhao QH, Xiao B. CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part II): imaging of pancreatic carcinoma nerve invasion. World J Radiol. 2012;4(1):13–20.PubMedPubMedCentralCrossRef
25.
Chang ST, Jeffrey RB, Patel BN, DiMaio MA, Rosenberg J, Willmann JK, et al. Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: preliminary experience and implications for patient care. Radiology. 2016;281(3):816–25.PubMedCrossRef
26.
27.
Seyal AR, Arslanoglu A, Abboud SF, Sahin A, Horowitz JM, Yaghmai V. CT of the abdomen with reduced tube voltage in adults: a practical approach. Radiographics. 2015;35(7):1922–39.PubMedCrossRef
28.
Lira D, Padole A, Kalra MK, Singh S. Tube potential and CT radiation dose optimization. Am J Roentgenol. 2015;204(1):W4–10.CrossRef
29.
Mayer C, Meyer M, Fink C, Schmidt B, Sedlmair M, Schoenberg SO, et al. Potential for radiation dose savings in abdominal and chest CT using automatic tube voltage selection in combination with automatic tube current modulation. Am J Roentgenol. 2014;203(2):292–9.CrossRef
30.
Nakaura T, Awai K, Oda S, Funama Y, Harada K, Uemura S, et al. Low-kilovoltage, high-tube-current MDCT of liver in thin adults: pilot study evaluating radiation dose, image quality, and display settings. Am J Roentgenol. 2011;196(6):1332–8.CrossRef
Metadata
Title
New method for the assessment of perineural invasion from perihilar cholangiocarcinoma
Authors
Hiroshi Tanaka
Tsuyoshi Igami
Yoshie Shimoyama
Tomoki Ebata
Yukihiro Yokoyama
Kensaku Mori
Masato Nagino
Publication date
01-01-2021
Publisher
Springer Singapore
Published in
Surgery Today / Issue 1/2021
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-020-02071-x

Other articles of this Issue 1/2021

Surgery Today 1/2021 Go to the issue

Guideline

The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018

Original Article

The predictive value of preoperative risk assessments and frailty for surgical complications in lung cancer patients

Original Article

Superiority of log odds of positive lymph nodes (LODDS) for prognostic prediction after gastric cancer surgery: a multi-institutional analysis of 7620 patients in China

How To Do It

Modified left subsuperior segmentectomy via 2-cm uniportal video-assisted thoracoscopic surgery

Original Article

Controlling lymph node micrometastases by neoadjuvant chemotherapy affects the prognosis in advanced esophageal squamous cell carcinoma

Original Article

The Controlling Nutritional Status (CONUT) Score as a prognostic factor for obstructive colorectal cancer patients received stenting as a bridge to curative surgery