title: Diagnosis of cholangiocarcinoma.
abstract: Cholangiocarcinoma is suspected based on signs of biliary obstruction, abnormal liver function tests, elevated tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen), and ultrasonography showing a bile stricture or a mass, especially in intrahepatic cholangiocarcinoma. Magnetic resonance imaging (MRI) or computed tomography (CT) is performed for the diagnosis and staging of cholangiocarcinomas. However, differentiation of an intraductal cholangiocarcinoma from a hypovascular metastasis is limited at imaging. Therefore, reasonable exclusion of an extrahepatic primary tumor should be performed. Differentiating between benign and malignant bile duct stricture is also difficult, except when metastases are observed. The sensitivity of fluorodeoxyglucose positron emission tomography is limited in small, infiltrative, and mucinous cholangiocarcinomas. When the diagnosis of a biliary stenosis remains indeterminate at MRI or CT, endoscopic imaging (endoscopic or intraductal ultrasound, cholangioscopy, or optical coherence tomography) and tissue sampling should be carried out. Tissue sampling has a high specificity for diagnosing malignant biliary strictures, but sensitivity is low. The diagnosis of cholangiocarcinoma is particularly challenging in patients with primary sclerosing cholangitis. These patients should be followed with yearly tumor markers, CT, or MRI. In the case of dominant stricture, histological or cytological confirmation of cholangiocarcinoma should be obtained. More studies are needed to compare the accuracy of the various imaging methods, especially the new intraductal methods, and the imaging features of malignancy should be standardized.
authors.affiliation: Diagnostic Radiology Unit, Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium. bernard.vanbeers@uclouvain.be
authors.forename: B E
authors.initials: BE
authors.lastname: Van Beers
references.citation: NIH Consens State Sci Statements. 2002 Jan 14-16;19(1):1-26
references.pmid: 14768653
references.citation: J Hepatol. 2006 Oct;45(4):568-74
references.pmid: 16879890
references.citation: Am J Gastroenterol. 2004 Sep;99(9):1690-1
references.pmid: 15330903
references.citation: Hepatology. 2006 Dec;44(6):1572-80
references.pmid: 17133469
references.citation: Cancer Lett. 2007 Mar 18;247(2):301-8
references.pmid: 16793202
references.citation: Gastrointest Endosc. 2005 Sep;62(3):374-82
references.pmid: 16111955
references.citation: Hepatology. 2006 Sep;44(3):658-66
references.pmid: 16941699
references.citation: J Comput Assist Tomogr. 1999 Sep-Oct;23(5):670-7
references.pmid: 10524843
references.citation: Aliment Pharmacol Ther. 2006 May 1;23(9):1287-96
references.pmid: 16629933
references.citation: J Hepatol. 2007 Nov;47(5):677-83
references.pmid: 17640760
references.citation: Am J Surg Pathol. 2000 Jun;24(6):870-6
references.pmid: 10843291
references.citation: World J Surg. 2004 May;28(5):466-70
references.pmid: 15085401
references.citation: Am J Gastroenterol. 2004 Jan;99(1):45-51
references.pmid: 14687140
references.citation: Am J Gastroenterol. 2000 Jan;95(1):204-7
references.pmid: 10638584
references.citation: J Nucl Med. 2005 Jul;46(7):1158-63
references.pmid: 16000285
references.citation: Gastrointest Endosc. 1995 Dec;42(6):565-72
references.pmid: 8674929
references.citation: Dig Dis Sci. 2005 Sep;50(9):1734-40
references.pmid: 16133981
references.citation: J Gastroenterol Hepatol. 2006 May;21(5):869-73
references.pmid: 16704538
references.citation: Radiographics. 2001 Oct;21 Spec No:S97-S116
references.pmid: 11598251
references.citation: Scand J Gastroenterol. 2000 Jan;35(1):77-82
references.pmid: 10672839
references.citation: Am J Gastroenterol. 2004 Sep;99(9):1684-9
references.pmid: 15330902
references.citation: Ann Surg. 2006 Aug;244(2):248-53
references.pmid: 16858187
references.citation: Oncologist. 2004;9(1):43-57
references.pmid: 14755014
references.citation: Gastroenterology. 1995 Mar;108(3):865-9
references.pmid: 7875490
references.citation: Eur J Nucl Med Mol Imaging. 2003 Nov;30(11):1467-72
references.pmid: 14579085
references.citation: Radiology. 2000 Jan;214(1):173-81
references.pmid: 10644119
references.citation: Gastrointest Endosc. 2002 Nov;56(5):720-30
references.pmid: 12397282
references.citation: Hepatogastroenterology. 2007 Jul-Aug;54(77):1348-52
references.pmid: 17708252
references.citation: Abdom Imaging. 2005 Jan-Feb;30(1):77-85
references.pmid: 15647875
references.citation: Radiographics. 1999 Sep-Oct;19(5):1199-218
references.pmid: 10489176
references.citation: J Comput Assist Tomogr. 1997 Jan-Feb;21(1):59-65
references.pmid: 9022771
references.citation: Gastrointest Endosc. 2002 Jun;55(7):870-6
references.pmid: 12024143
references.citation: Dig Dis Sci. 2007 Nov;52(11):3123-35
references.pmid: 17431781
references.citation: Am J Gastroenterol. 2004 Mar;99(3):523-6
references.pmid: 15056096
references.citation: Lancet. 2005 Oct 8;366(9493):1303-14
references.pmid: 16214602
references.citation: Gastrointest Endosc. 2002 Jan;55(1):84-8
references.pmid: 11756925
references.citation: Am J Clin Pathol. 2005 Sep;124(3):355-60
references.pmid: 16191503
references.citation: J Hepatol. 2005 Aug;43(2):358-60
references.pmid: 15975687
references.citation: Gastrointest Endosc. 2005 Jul;62(1):1-8
references.pmid: 15990812
references.citation: Scand J Gastroenterol. 2005 Apr;40(4):455-9
references.pmid: 16028441
references.citation: Radiology. 1996 Mar;198(3):869-73
references.pmid: 8628885
references.citation: Gut. 2007 Jul;56(7):1032
references.pmid: 17566044
references.citation: Gastrointest Endosc. 2004 Sep;60(3):390-6
references.pmid: 15332029
references.citation: Am J Gastroenterol. 2006 Feb;101(2):284-91
references.pmid: 16454832
references.citation: J Gastrointest Surg. 2004 Jan;8(1):90-7
references.pmid: 14746840
references.citation: World J Surg. 1999 Oct;23(10):1038-43; discussion 1043-4
references.pmid: 10512944
references.citation: Scand J Gastroenterol. 2002 Oct;37(10):1205-11
references.pmid: 12408527
references.citation: J Hepatol. 2006 Dec;45(6):856-67
references.pmid: 17030071
references.citation: Nucl Med Commun. 2001 Dec;22(12):1277-85
references.pmid: 11711897
references.citation: Gut. 2002 Aug;51(2):240-4
references.pmid: 12117887
references.citation: Gastrointest Endosc. 2000 Apr;51(4 Pt 1):383-90
references.pmid: 10744806
references.citation: Gut. 2002 Nov;51 Suppl 6:VI1-9
references.pmid: 12376491
references.citation: Hepatology. 1998 Sep;28(3):700-6
references.pmid: 9731562
references.citation: Liver. 1999 Dec;19(6):501-8
references.pmid: 10661684
references.citation: Semin Liver Dis. 2004 May;24(2):139-54
references.pmid: 15192787
references.citation: Gastrointest Endosc. 2002 Jul;56(1):40-7
references.pmid: 12085033
references.citation: Surg Today. 2007;37(6):530-3
references.pmid: 17522778
references.citation: Radiology. 2005 Jul;236(1):178-83
references.pmid: 15955859
references.citation: J Nucl Med. 2001 Sep;42(9):1412-7
references.pmid: 11535734
references.citation: Endoscopy. 2000 Jan;32(1):3-9
references.pmid: 10691265
references.citation: Radiology. 2007 Jan;242(1):23-31
references.pmid: 17185659
references.citation: Clin Gastroenterol Hepatol. 2004 Mar;2(3):209-13
references.pmid: 15017604
references.citation: Cytopathology. 2006 Feb;17(1):42-9
references.pmid: 16417564
references.citation: Gastrointest Endosc. 2006 Sep;64(3):325-33
references.pmid: 16923477
references.citation: Ann Intern Med. 2003 Oct 7;139(7):547-57
references.pmid: 14530225
references.citation: AJR Am J Roentgenol. 2006 Aug;187(2):445-53
references.pmid: 16861550
references.citation: J Natl Compr Canc Netw. 2009 Apr;7(4):350-91
references.pmid: 19406039
references.citation: AJR Am J Roentgenol. 1997 Apr;168(4):985-9
references.pmid: 9124155
references.citation: J Surg Oncol. 2004 Aug 1;87(2):80-3; discussion 83-4
references.pmid: 15282700
references.citation: Gastrointest Endosc. 2007 Jul;66(1):97-9
references.pmid: 17591480
references.citation: Endoscopy. 2005 Aug;37(8):715-21
references.pmid: 16032489
references.citation: Radiology. 2004 Oct;233(1):234-40
references.pmid: 15333766
references.citation: J Hepatol. 2006 Jul;45(1):43-50
references.pmid: 16690156
references.citation: Hepatology. 2001 May;33(5):1029-35
references.pmid: 11343227
references.citation: Gastroenterology. 2006 Oct;131(4):1064-72
references.pmid: 17030177
references.citation: Dig Surg. 2006;23(5-6):319-24
references.pmid: 17170527
references.citation: J Am Coll Surg. 2005 Dec;201(6):862-9
references.pmid: 16310689