[Malignant hepatobiliary tumors. Surgical requirements concerning preoperative diagnosis]

Depending on the results of the diagnostic work-up of a hepatobiliary tumour, the further therapeutic strategy may vary appreciably. The data needed to decide whether a malignant growth is resectable or not include information on the nature, size and location of the tumour, the number of lesions presenting, extrahepatic tumour-related manifestations, the individual hepatic anatomy and additional liver diseases. Despite the recent technical advances, the various diagnostic imaging procedures all have their limitations; used in combination, however, they can provide adequate information in 90-100% of the cases. The most important of these procedures are ultrasonography and spiral CT--including the use of contrast agents--and in some cases also MRT. Thanks to the topographic information they provide, the three-dimensional methods are gaining popularity. While angiography, scintigraphy and ERCP are useful supplementary methods, they do not suffice for the primary diagnosis. In some cases, intra-operative diagnosis may make necessary a change in the planned therapeutic procedure. The limitations and possibilities of the diagnostic strategy--which in no small part is also codetermined by the patient's prehistory and the experience of the examiner--are discussed.