Learning objectives
To provide a comprehensive review of the role of image-guided interventional procedures in the diagnosis and management of hepatobiliary and pancreatic malignancies
To outline the pearls and pitfalls relevant to the interpretation of pre and post-procedural imaging studies.
Background
The incidence of hepatobiliary and pancreatic (HBP) malignancies (hepatocellular carcinoma, cholangiocarcinoma, pancreatic adenocarcinoma, neuroendocrine tumours and hepatic metastasis) is steadily increasing worldwide, in part due to the improvements in imaging techniques and availability, as well as an aging population(1). Primary HBP malignancies are often diagnosed at an advanced stage when curative surgical options are limited. However, recent years has seen a shift towards earlier diagnoses through timely investigation of incidental imaging findings in conjunction with minimally invasive therapies which can be curative or palliative in...
Imaging findings OR Procedure details
DIAGNOSIS
Most HBP malignancies are initially detected on cross-section imaging studies. In most cases, a primary malignancy such as hepatocellular carcinoma (HCC) or pancreatic adenocarcinoma can be diagnosed with confidence on imaging alone when typical imaging features are demonstrated(6). However, tissue diagnosis is occasionally required when imaging features are equivocal, where liver metastases are present without an obvious primary source or when advanced molecular or mutation testing is necessary to guide subsequent systemic therapy including recruitment to clinical trials(7).
Specific biopsy techniques include percutaneous core...
Conclusion
Interventional oncology procedures have become an established component for the management of HBP malignancies. An awareness of the versatile spectrum of diagnostic and therapeutic procedures in this setting will assist clinicians and Radiologists in providing the optimal patient outcome.
Personal information
Jennifer Yeh1, MD, BTech
Tuck Yong2, FRACS
Sum Leong3, FFRRCSI, EDIR
David Burrows1,FRANZCR
Hong Kuan Kok1, FFRRCSI, FRCR, FRANZCR, EBIR
1Department of Radiology, Northern Hospital, Melbourne, AU
2Department of Hepatobiliary Surgery, Northern Hospital, Melbourne, AU
3Department of Radiology, Singapore General Hospital, SG
References
1.Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6):394-424.
2.Bjerregaard JK, Mortensen MB, Pfeiffer P. Trends in cancer of the liver, gall bladder, bile duct, and pancreas in elderly in Denmark, 1980–2012. Acta Oncologica. 2016;55(sup1):40-5.
3.Kabbach G, Assi HA, Bolotin G, Schuster M, Lee HJ, Tadros M. Hepatobiliary Tumors: Update on Diagnosis and Management. J Clin Transl Hepatol....