Staging cholangiocarcinoma by imaging studies.
Cholangiocarcinoma (CCA) is an adenocarcinoma that arises from the bile duct epithelium and is observed in the entire biliary tree (intrahepatic, hilum, and extrahepatic distal). The staging of this tumor differs depending on location. The role of imaging in the staging of hilar CCA is to assess the extent of ductal involvement by the tumor, hepatic artery, or portal venous involvement, the functional status and volumetric assessment of the underlying liver, and the regional or distant tumor extension. Complete assessment is done by combining magnetic resonance (MR) cholangiography and multidetector computed tomography (CT). Multidetector CT, in particular, is accurate for resectability and the negative predictive value (patients with disease classified as unresectable and in whom unresectability has been confirmed) is quite high: 85-100%. The role of imaging in the staging of intrahepatic CCA is to evaluate resectability based on the tumor itself, vascular involvement, regional and distal extension, and volumetric assessment of the contralateral liver, and to determine the prognostic factors. These factors are mainly: tumor size, the presence of satellite nodules, vascular involvement, and lymph nodes. CT and MR imaging (MRI) are keys and their results are comparable. In distal extrahepatic CCA due to tumor location, staging is focused mainly on the adjacent vessels (portal vein and hepatic artery), the hepatoduodenal ligament, the proximal and distal biliary extent, and pancreatic invasion. CT and MRI are mandatory.
Vilgrain
V
V
Department of Radiology, Hôpital Beaujon, Paris, France. valerie.vilgrain@bjn.aphp.fr
Am J Surg. 2007 Jun;193(6):702-6
17512280
J Hepatobiliary Pancreat Surg. 2004;11(5):310-8
15549429
Radiol Med. 2001 Jul-Aug;102(1-2):48-54
11677438
J Gastroenterol Hepatol. 2008 May;23(5):759-65
17931372
J Comput Assist Tomogr. 1997 Jan-Feb;21(1):59-65
9022771
J Gastrointest Surg. 2003 Nov;7(7):850-6
14592657
J Gastrointest Surg. 2004 Jan;8(1):90-7
14746840
Radiology. 1988 Jun;167(3):689-93
2834769
AJR Am J Roentgenol. 2005 May;184(5):1572-7
15855117
Cancer. 2001 Nov 1;92(9):2374-83
11745293
Abdom Imaging. 2000 Sep-Oct;25(5):500-7
10931985
J Hepatobiliary Pancreat Surg. 2005;12(6):479-83
16365823
Eur J Nucl Med Mol Imaging. 2002 Aug;29(8):1047-54
12173019
J Comput Assist Tomogr. 1999 Sep-Oct;23(5):670-7
10524843
Eur Radiol. 2006 Oct;16(10):2317-25
16622690
AJR Am J Roentgenol. 1998 Sep;171(3):651-8
9725291
Int J Colorectal Dis. 2001 Jun;16(3):188-92
11459293
Radiology. 2001 Jul;220(1):90-6
11425978
Radiographics. 1997 Nov-Dec;17(6):1475-85
9397459
World J Surg. 2003 Mar;27(3):278-83
12607051
Radiology. 2006 Apr;239(1):113-21
16467211
Gastrointest Endosc. 2002 Jul;56(1):25-32
12085031
Gut. 2000 Jan;46(1):103-6
10601064
J Hepatobiliary Pancreat Surg. 2003;10(4):288-91
14598147
Radiol Med. 1994 Jul-Aug;88(1-2):63-7
8066257
AJR Am J Roentgenol. 1999 Jan;172(1):73-7
9888743
Am J Gastroenterol. 2000 Feb;95(2):432-40
10685746
J Hepatol. 2006 Jul;45(1):43-50
16690156
Hepatology. 2001 May;33(5):1029-35
11343227