Image diagnostics for carcinoma of the biliary tract

Although it is clear that US is the procedure which should be selected as a method of the first choice to detect carcinoma of the biliary tract, a rational selection and combination of diagnostic procedures are essential for further evaluation on the nature or extension of tumor and its resectability. The next procedure which should be selected after US, in our opinion, is ERCP which can be followed by ERBD, if necessary, because it is useful to know the site and extension of tumor. However, the cases who have the lesion at the upper portion of the biliary tract or which is considered to be unresectable should be converted to percutaneous transhepatic approaches (PTC, PTBD, PTCS) at this stage as a method of next choice with diagnostic and subsequent therapeutic purposes. On the other hand, EUS is also an important first line diagnostic procedure to delineate the lesion at the lower portion of the biliary tract which can be used in parallel with ERCP. In this paper, usefulness of EUS was strongly advocated, because the information concerning the extension and resectability of tumor are also provided with it as it is obtained with CT, MRT and angiography. Cytology of bile, cholecystography, percutaneous transhepatic cholangioscopy and biopsy under endoscopic control carried out after percutaneous transhepatic drainage of the gallbladder are the procedures used for the diagnosis of gallbladder carcinoma, but they should be only indicated in the cases, in which early carcinoma is strongly suspected, because it cannot provide us any information necessary to make therapeutic plan in the cases with advanced carcinoma.