What are the best investigations for hepatobiliary (liver and bile duct) tumors?

From the Guidelines

The best investigations for hepatobiliary tumors include a combination of imaging studies and laboratory tests, with multiphase CT and liver MRI (with MRCP) being the preferred initial imaging modalities, as recommended by the most recent guidelines 1. The initial evaluation should begin with a non-invasive assessment, such as ultrasound, to quickly identify any potential issues, followed by more detailed characterization of lesions using contrast-enhanced CT or MRI. Some key points to consider when evaluating hepatobiliary tumors include:

• The use of tumor markers, such as CA 19-9 for cholangiocarcinoma, to support a diagnosis, although their sensitivity and specificity can vary 1.
• The importance of tissue sampling via ultrasound or CT-guided biopsy for definitive diagnosis, as imaging studies alone may not be sufficient 1.
• The potential role of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) in obtaining tissue samples and relieving obstruction in biliary tract tumors 1.
• The use of PET-CT to detect metastatic disease and assess treatment response, although its routine use is not recommended for staging 1. The specific sequence of tests should be tailored to the clinical presentation and suspected tumor type, with the goal of achieving accurate diagnosis, staging, and treatment planning for hepatobiliary tumors. In terms of the diagnostic workup, it is recommended to prioritize multiphase CT of chest, abdomen, and pelvis, as well as liver MRI (with MRCP in biliary diseases) 1. Additionally, a needle biopsy of the liver tumor should be performed to confirm the diagnosis and eliminate differential diagnoses 1.

From the Research

Investigations for Hepatobiliary Tumors

The following are some of the best investigations for hepatobiliary tumors:

• Imaging tests such as MRI, CT, and ultrasound are commonly used for the diagnosis and staging of hepatobiliary tumors 2, 3, 4
• MRI is particularly useful for characterizing lesions and differentiating between benign and malignant tumors 3, 4
• CT arterial portography is also useful for detecting small lesions, but non-invasive techniques such as contrast-enhanced helical CT and MR are becoming increasingly popular 4
• Functional imaging such as 2-fluoro-2-deoxy-D-glucose-positron-emission tomography (FDG-PET) can be used to detect intrahepatic tumor and extrahepatic disease 4
• Abdominal ultrasound and alpha-foetoprotein (AFP) can be used as triage tests for the diagnosis of hepatocellular carcinoma (HCC) in adults with chronic liver disease 5
• The combination of AFP and ultrasound has been shown to have the highest sensitivity for detecting HCC, with less than 5% of occurrences being missed 5

Diagnostic Accuracy of Investigations

The diagnostic accuracy of various investigations for hepatobiliary tumors is as follows:

• AFP: sensitivity 60% (95% CI 58% to 62%), specificity 84% (95% CI 82% to 86%) for HCC 5
• Ultrasound: sensitivity 72% (95% CI 63% to 79%), specificity 94% (95% CI 91% to 96%) for HCC 5
• Combination of AFP and ultrasound: sensitivity 96% (95% CI 88% to 98%), specificity 85% (95% CI 73% to 93%) for HCC 5

Staging and Management

Imaging tests are also essential for staging and managing hepatobiliary tumors, including:

• Determining the extent of tumor spread and involvement of surrounding tissues 2, 4
• Planning surgical interventions, such as liver resection or transplantation 2, 4
• Monitoring response to treatment and detecting recurrence 6