Bile duct carcinoma without jaundice: clues to early diagnosis

Most bile duct carcinomas are diagnosed at an advanced stage, after the appearance of jaundice. The features of bile duct carcinomas without jaundice were analyzed with the aim of allowing early diagnosis in such cases.

Clinicopathological features, images and surgical outcomes were compared between 18 non-jaundiced and 85 jaundiced patients with extrahepatic bile duct carcinoma.

Among the non-jaundiced patients, 13 were symptomatic. Abnormalities on hepatic function and tumor marker tests were seen in 56% and 44%, respectively. In all 18 cases, ultrasonography demonstrated biliary abnormalities including masses (9 patients) and strictures (5 patients). The diagnosis was confirmed histologically by transpapillary bile duct biopsy in eight of 10 non-jaundiced patients. The non-jaundiced patients (83%) had a higher rate of resectability than jaundiced patients (58%). Pathological findings of resected specimens showed no significant differences between the two groups. The non-jaundiced group had a significantly higher survival rate than the jaundiced group: 50% vs. 22% at 5 years.

For early diagnosis of bile duct carcinomas not associated with jaundice, detailed ultrasonographic examination is useful, and subtle changes indicate a need for direct cholangiography. Non-jaundiced cases have the potential for curative resection.