Abdominal Imaging

, Volume 38, Issue 5, pp 1071–1081 | Cite as

Imaging bile duct tumors: staging

Article

Abstract

Cholangiocarcinoma (CC) is the most frequent neoplasm of the biliary system. According to its anatomic origin in the biliary tree it is usually classified as intrahepatic, perihilar, or extrahepatic distal CC. Tumors originated in these areas differ in biological behavior and management. The stratification of the patients aligned to therapeutic options and prognosis is a key point in the management of CC. Thus, specific staging systems have been designed for each anatomical location. They are precise for surgical planning, to establish prognosis after surgery, or to compare the benefits of different therapeutic approaches, but they are less accurate to stratify patients into a therapeutic decision algorithm. Imaging tools, mainly multidetector computed tomography and magnetic resonance imaging (MRI), allow full assessment of the diagnosis and extension of the tumor. They are especially useful in establishing the correct diagnosis and determining resectability, which reaches a high negative predictive value, identifying those patients in whom surgery will not be effective. We will discuss the different staging systems for CC, the radiologic characteristics with classical and recently described signs that allow a confident diagnosis of the disease and the criteria for resectability of biliary tract malignancies.

Keywords

Cholangiocarcinoma Staging MDCT MRI Review 

References

  1. 1.
    Yamasaki S (2003) Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J Hepatobiliary Pancreat Surg 10:288–291PubMedCrossRefGoogle Scholar
  2. 2.
    Razumilava N, Gores GJ (2013) Classification, diagnosis, and management of cholangiocarcinoma. Clin Gastroenterol Hepatol 11:13–21PubMedCrossRefGoogle Scholar
  3. 3.
    Deoliveira ML, Schulick RD, Nimura Y, et al. (2011) New staging system and a registry for perihilar cholangiocarcinoma. Hepatology 53:1363–1371PubMedCrossRefGoogle Scholar
  4. 4.
    Blechacz B, Komuta M, Roskams T, Gores GJ (2011) Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 8:512–522PubMedCrossRefGoogle Scholar
  5. 5.
    Deoliveira ML, Cunningham SC, Cameron JL, et al. (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245:755–762PubMedCrossRefGoogle Scholar
  6. 6.
    Singh MK, Facciuto ME (2012) Current management of cholangiocarcinoma. Mt Sinai J Med 79:232–245PubMedCrossRefGoogle Scholar
  7. 7.
    Jonas S, Thelen A, Benckert C, et al. (2009) Extended liver resection for intrahepatic cholangiocarcinoma: a comparison of the prognostic accuracy of the fifth and sixth editions of the TNM classification. Ann Surg 249:303–309PubMedCrossRefGoogle Scholar
  8. 8.
    Lang H, Sotiropoulos GC, Sgourakis G, et al. (2009) Operations for intrahepatic cholangiocarcinoma: single-institution experience of 158 patients. J Am Coll Surg 208:218–228PubMedCrossRefGoogle Scholar
  9. 9.
    Uenishi T, Kubo S, Yamazaki O, et al. (2008) Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases. J Hepatobiliary Pancreat Surg 15:417–422PubMedCrossRefGoogle Scholar
  10. 10.
    Nathan H, Aloia TA, Vauthey JN, et al. (2009) A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol 16:14–22PubMedCrossRefGoogle Scholar
  11. 11.
    Edge SB (2009) American Joint Committee on Cancer: AJCC cancer staging manual, 7th edn. New York: SpringerGoogle Scholar
  12. 12.
    Farges O, Fuks D, Le Treut YP, et al. (2011) AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma: by the AFC-IHCC-2009 Study Group. Cancer 117:2170–2177PubMedCrossRefGoogle Scholar
  13. 13.
    Sotiropoulos GC, Miyazaki M, Konstadoulakis MM, et al. (2010) Multicentric evaluation of a clinical and prognostic scoring system predictive of survival after resection of intrahepatic cholangiocarcinomas. Liver Int 30:996–1002PubMedCrossRefGoogle Scholar
  14. 14.
    Marsh RW, Alonzo M, Bajaj S, et al. (2012) Comprehensive review of the diagnosis and treatment of biliary tract cancer 2012. Part I: diagnosis-clinical staging and pathology. J Surg Oncol 106:332–338CrossRefGoogle Scholar
  15. 15.
    Valls C, Guma A, Puig I, et al. (2000) Intrahepatic peripheral cholangiocarcinoma: CT evaluation. Abdom Imaging 25:490–496PubMedCrossRefGoogle Scholar
  16. 16.
    Kim SA, Lee JM, Lee KB, et al. (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern—correlation with clinicopathologic findings. Radiology 260:148–157PubMedCrossRefGoogle Scholar
  17. 17.
    Rimola J, Forner A, Reig M, et al. (2009) Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma. Hepatology 50:791–798PubMedCrossRefGoogle Scholar
  18. 18.
    Park HJ, Kim YK, Park MJ, Lee WJ (2012) Small intrahepatic mass-forming cholangiocarcinoma: target sign on diffusion-weighted imaging for differentiation from hepatocellular carcinoma. Abdom Imaging. doi: 10.1007/s00261-012-9943-x
  19. 19.
    Vilgrain V, Van Beers BE, Flejou JF, et al. (1997) Intrahepatic cholangiocarcinoma: MRI and pathologic correlation in 14 patients. J Comput Assist Tomogr 21:59–65PubMedCrossRefGoogle Scholar
  20. 20.
    Okabayashi T, Yamamoto J, Kosuge T, et al. (2001) A new staging system for mass-forming intrahepatic cholangiocarcinoma: analysis of preoperative and postoperative variables. Cancer 92:2374–2383PubMedCrossRefGoogle Scholar
  21. 21.
    Kang Y, Lee JM, Kim SH, Han JK, Choi BI (2012) Intrahepatic mass-forming cholangiocarcinoma: enhancement patterns on gadoxetic acid-enhanced MR images. Radiology 264:751–760PubMedCrossRefGoogle Scholar
  22. 22.
    Vilgrain V (2008) Staging cholangiocarcinoma by imaging studies. HPB (Oxford) 10:106–109CrossRefGoogle Scholar
  23. 23.
    Kim JY, Kim MH, Lee TY, et al. (2008) Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol 103:1145–1151PubMedCrossRefGoogle Scholar
  24. 24.
    Lee SW, Kim HJ, Park JH, et al. (2010) Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol 45:560–566PubMedCrossRefGoogle Scholar
  25. 25.
    Corvera CU, Blumgart LH, Akhurst T, et al. (2008) 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg 206:57–65PubMedCrossRefGoogle Scholar
  26. 26.
    Marsh RW, Alonzo M, Bajaj S, et al. (2012) Comprehensive review of the diagnosis and treatment of biliary tract cancer 2012. Part II: multidisciplinary management. J Surg Oncol 106:339–345CrossRefGoogle Scholar
  27. 27.
    Dhanasekaran R, Hemming AW, Zendejas I, et al. (2013) Treatment outcomes and prognostic factors of intrahepatic cholangiocarcinoma. Oncol Rep 29:1259–1267PubMedGoogle Scholar
  28. 28.
    Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140:170–178PubMedGoogle Scholar
  29. 29.
    Jarnagin WR, Fong Y, DeMatteo RP, et al. (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517PubMedCrossRefGoogle Scholar
  30. 30.
    Matsuo K, Rocha FG, Ito K, et al. (2012) The Blumgart preoperative staging system for hilar cholangiocarcinoma: analysis of resectability and outcomes in 380 patients. J Am Coll Surg 215:343–355PubMedCrossRefGoogle Scholar
  31. 31.
    Zervos EE, Osborne D, Goldin SB, et al. (2005) Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach. Am J Surg 190:810–815PubMedCrossRefGoogle Scholar
  32. 32.
    Nagino M (2011) Perihilar cholangiocarcinoma: a much needed but imperfect new staging system. Nat Rev Gastroenterol Hepatol 8:252–253PubMedGoogle Scholar
  33. 33.
    Gore RM, Shelhamer RP (2007) Biliary tract neoplasms: diagnosis and staging. Cancer Imaging 7 Spec No A:S15–S23Google Scholar
  34. 34.
    Masselli G, Gualdi G (2008) Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning. Abdom Imaging 33:444–451PubMedCrossRefGoogle Scholar
  35. 35.
    Tirapu de Sagrario MG, Baleato GS, Garcia FR, Coessens A (2013) Intraductal biliary metastases from colorectal cancer: a report of two cases. Radiologia. doi: 10.1016/j.rx.2013.01.005
  36. 36.
    Charatcharoenwitthaya P, Enders FB, Halling KC, Lindor KD (2008) Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology 48:1106–1117PubMedCrossRefGoogle Scholar
  37. 37.
    Cui XY, Chen HW (2010) Role of diffusion-weighted magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma. World J Gastroenterol 16:3196–3201PubMedCrossRefGoogle Scholar
  38. 38.
    Cui XY, Chen HW, Cai S, et al. (2012) Diffusion-weighted MR imaging for detection of extrahepatic cholangiocarcinoma. Eur J Radiol 81:2961–2965PubMedCrossRefGoogle Scholar
  39. 39.
    Kim JE, Lee JM, Kim SH, et al. (2010) Differentiation of intraductal growing-type cholangiocarcinomas from nodular-type cholangiocarcinomas at biliary MR imaging with MR cholangiography. Radiology 257:364–372PubMedCrossRefGoogle Scholar
  40. 40.
    Takanami K, Yamada T, Tsuda M, et al. (2011) Intraductal papillary mucininous neoplasm of the bile ducts: multimodality assessment with pathologic correlation. Abdom Imaging 36:447–456PubMedCrossRefGoogle Scholar
  41. 41.
    Choi JY, Kim MJ, Lee JM, et al. (2008) Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 191:1448–1457PubMedCrossRefGoogle Scholar
  42. 42.
    Hattori M, Nagino M, Ebata T, et al. (2011) Prospective study of biliary cytology in suspected perihilar cholangiocarcinoma. Br J Surg 98:704–709PubMedCrossRefGoogle Scholar
  43. 43.
    Halling KC, Kipp BR (2007) Fluorescence in situ hybridization in diagnostic cytology. Hum Pathol 38:1137–1144PubMedCrossRefGoogle Scholar
  44. 44.
    Lee HY, Kim SH, Lee JM, et al. (2006) Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria. Radiology 239:113–121PubMedCrossRefGoogle Scholar
  45. 45.
    Kim HJ, Kim AY, Hong SS, et al. (2006) Biliary ductal evaluation of hilar cholangiocarcinoma: three-dimensional direct multi-detector row CT cholangiographic findings versus surgical and pathologic results—feasibility study. Radiology 238:300–308PubMedCrossRefGoogle Scholar
  46. 46.
    Masselli G, Manfredi R, Vecchioli A, Gualdi G (2008) MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Eur Radiol 18:2213–2221PubMedCrossRefGoogle Scholar
  47. 47.
    Aloia TA, Charnsangavej C, Faria S, et al. (2007) High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg 193:702–706PubMedCrossRefGoogle Scholar
  48. 48.
    Forsmo HM, Horn A, Viste A, Hoem D, Ovrebo K (2008) Survival and an overview of decision-making in patients with cholangiocarcinoma. Hepatobiliary Pancreat Dis Int 7:412–417PubMedGoogle Scholar
  49. 49.
    Sacks A, Peller PJ, Surasi DS, et al. (2011) Value of PET/CT in the management of primary hepatobiliary tumors, part 2. AJR Am J Roentgenol 197:W260–W265PubMedCrossRefGoogle Scholar
  50. 50.
    Ruys AT, van Beem BE, Engelbrecht MR, et al. (2012) Radiological staging in patients with hilar cholangiocarcinoma: a systematic review and meta-analysis. Br J Radiol 85:1255–1262PubMedCrossRefGoogle Scholar
  51. 51.
    Hong SM, Pawlik TM, Cho H, et al. (2009) Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma. Surgery 146:250–257PubMedCrossRefGoogle Scholar
  52. 52.
    Murakami Y, Uemura K, Sudo T, et al. (2010) Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg 211:196–204PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Radiology Department, Centre de Diagnòstic per la Imatge Clínic (CDIC)Hospital ClínicBarcelonaSpain

Personalised recommendations