Cholangiocarcinoma diagnostic study of choice: Difference between revisions

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{{Cholangiocarcinoma}}
{{Cholangiocarcinoma}}
{{CMG}}; {{AE}}
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== Overview ==
== Overview ==
The staging of cholangiocarcinoma varies depending on whether the tumor is primarily intrahepatic (ICC), hilar/perihilar, or extrahepatic.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
The staging of cholangiocarcinoma varies depending on whether the tumor is primarily intrahepatic (ICC), hilar/perihilar, or extrahepatic.<ref name="pmid21808282">{{cite journal |vauthors=Blechacz B, Komuta M, Roskams T, Gores GJ |title=Clinical diagnosis and staging of cholangiocarcinoma |journal=Nat Rev Gastroenterol Hepatol |volume=8 |issue=9 |pages=512–22 |year=2011 |pmid=21808282 |pmc=3331791 |doi=10.1038/nrgastro.2011.131 |url=}}</ref><ref name="pmid21460876">{{cite journal |vauthors=Patel T |title=Cholangiocarcinoma--controversies and challenges |journal=Nat Rev Gastroenterol Hepatol |volume=8 |issue=4 |pages=189–200 |year=2011 |pmid=21460876 |pmc=3888819 |doi=10.1038/nrgastro.2011.20 |url=}}</ref><ref name="pmid25267346">{{cite journal |vauthors=Groot Koerkamp B, Wiggers JK, Allen PJ, Busch OR, D'Angelica MI, DeMatteo RP, Fong Y, Gonen M, Gouma DJ, Kingham TP, van Gulik TM, Jarnagin WR |title=American Joint Committee on Cancer staging for resected perihilar cholangiocarcinoma: a comparison of the 6th and 7th editions |journal=HPB (Oxford) |volume=16 |issue=12 |pages=1074–82 |year=2014 |pmid=25267346 |pmc=4253330 |doi=10.1111/hpb.12320 |url=}}</ref><ref name="pmid28261593">{{cite journal |vauthors=Ronnekleiv-Kelly SM, Pawlik TM |title=Staging of intrahepatic cholangiocarcinoma |journal=Hepatobiliary Surg Nutr |volume=6 |issue=1 |pages=35–43 |year=2017 |pmid=28261593 |pmc=5332207 |doi=10.21037/hbsn.2016.10.02 |url=}}</ref>


===== Template statements =====
===Staging===
====Intrahepatic cholangiocarcinoma staging====


=== Study of choice: ===
{| class="wikitable" align="right"
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
* The following result of [gold standard test] is confirmatory of [disease name]:
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''T'''
** Result 1
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''N'''
** Result 2
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''M'''
* The [name of the investigation] should be performed when:
|-
** The patient presented with symptoms/signs 1. 2, 3.
| style="background:#DCDCDC;" align="center" + |IA
** A positive [test] is detected in the patient.
| style="background:#F5F5F5;" + |T1
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
| style="background:#F5F5F5;" + |N0
* The diagnostic study of choice for [disease name] is [name of the investigation].
| style="background:#F5F5F5;" + |M0
* There is no single diagnostic study of choice for the diagnosis of [disease name].
|-
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
| style="background:#DCDCDC;" align="center" + |IB
* [Disease name] is mainly diagnosed based on clinical presentation.
| style="background:#F5F5F5;" + |T2
* Investigations:
| style="background:#F5F5F5;" + |N0
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
| style="background:#F5F5F5;" + |M0
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
|-
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
| style="background:#DCDCDC;" align="center" + |IIA
 
| style="background:#F5F5F5;" + |T3
==== The comparison table for diagnostic studies of choice for [disease name] ====
| style="background:#F5F5F5;" + |N0
{|
| style="background:#F5F5F5;" + |M0
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|-
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
| style="background:#DCDCDC;" align="center" + |IIB
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
| style="background:#F5F5F5;" + |T1-3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
| style="background:#F5F5F5;" + |N1
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |III
| style="background:#F5F5F5;" + |T4
| style="background:#F5F5F5;" + |Any N
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IV
| style="background:#F5F5F5;" + |Any T
| style="background:#F5F5F5;" + |Any N
| style="background:#F5F5F5;" + |M1
|}
{| class="wikitable" align="center"
| colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''AJCC 2010'''
|-
! rowspan="6" style="background:#DCDCDC;" align="center" + | T
| style="background:#DCDCDC;" align="center" + | Tis
| style="background:#F5F5F5;" + |The tumour is only within the top layers of cells lining the [[bile duct]]
|-
| style="background:#DCDCDC;" align="center" + |T1
| style="background:#F5F5F5;" + |There is one tumor that is contained within the [[bile duct]], but has grown deeper into the wall of the [[bile duct]]
|-
| style="background:#DCDCDC;" align="center" + |T2a
| style="background:#F5F5F5;" + |There is one tumor and it has grown through the wall of the bile duct into a nearby blood vessel
|-
| style="background:#DCDCDC;" align="center" + |T2b
| style="background:#F5F5F5;" + |There is more than one tumour which may or may not have grown into a nearby blood vessel
|-
| style="background:#DCDCDC;" align="center" + |T3
| style="background:#F5F5F5;" + | The tumour has either grown into the covering of the liver (the peritoneum) or has grown into nearby structures outside the liver, such as the bowel
|-
| style="background:#DCDCDC;" align="center" + |T4
| style="background:#F5F5F5;" + |The tumour has spread into the liver by growing along the ducts
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + | N
| style="background:#DCDCDC;" align="center" + |N0
| style="background:#F5F5F5;" + |There are no cancer cells in the [[Lymph node|lymph nodes]]
|-
| style="background:#DCDCDC;" align="center" + |N1
| style="background:#F5F5F5;" + |There are cancer cells in the [[Lymph node|lymph nodes]]
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + | M
| style="background:#DCDCDC;" align="center" + |M0
| style="background:#F5F5F5;" + |There is no sign of [[cancer]] spread
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background:#DCDCDC;" align="center" + |M1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background:#F5F5F5;" + |The cancer has spread to other parts of the body away from the [[bile duct]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
====Perhilar cholangiocarcinoma====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2


===== Sequence of Diagnostic Studies =====
{| class="wikitable" align="right"
The [name of investigation] should be performed when:
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''T'''
* A positive [test] is detected in the patient, to confirm the diagnosis.
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''N'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''M'''
|-
| style="background:#DCDCDC;" align="center" + |IA
| style="background:#F5F5F5;" + |T1
| style="background:#F5F5F5;" + |N0
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IB
| style="background:#F5F5F5;" + |T2
| style="background:#F5F5F5;" + |N0
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IIA
| style="background:#F5F5F5;" + |T3
| style="background:#F5F5F5;" + |N0
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IIB
| style="background:#F5F5F5;" + |T1-3
| style="background:#F5F5F5;" + |N1
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |III
| style="background:#F5F5F5;" + |T4
| style="background:#F5F5F5;" + |Any N
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IV
| style="background:#F5F5F5;" + |Any T
| style="background:#F5F5F5;" + |Any N
| style="background:#F5F5F5;" + |M1
|}
{| class="wikitable" align="center"
| colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''AJCC 2010'''
|-
! rowspan="6" style="background:#DCDCDC;" align="center" + | T
| style="background:#DCDCDC;" align="center" + | Tis
| style="background:#F5F5F5;" + |The tumor is only within the top layers of cells lining the [[bile duct]]
|-
| style="background:#DCDCDC;" align="center" + |T1
| style="background:#F5F5F5;" + |The tumor has grown deeper into the wall of the [[bile duct]]
|-
| style="background:#DCDCDC;" align="center" + |T2a
| style="background:#F5F5F5;" + |The tumor has grown through the wall of the bile duct into the fatty tissue around it
|-
| style="background:#DCDCDC;" align="center" + |T2b
| style="background:#F5F5F5;" + |The tumor has grown into the main part of the liver next to the [[bile duct]]
|-
| style="background:#DCDCDC;" align="center" + |T3
|The tumor has grown into one of the main blood vessels of the [[liver]] (the [[portal vein]] or [[hepatic artery]])
|-
| style="background:#DCDCDC;" align="center" + |T4
|The tumour has grown into the right and left hepatic [[Bile duct|bile ducts]]. Or it has grown into more than one of the blood vessels. Or it has grown into a hepatic bile duct and more than one blood vessel
|-
! rowspan="3" style="background:#DCDCDC;" align="center" + | N
| style="background:#DCDCDC;" align="center" + |N0
| style="background:#F5F5F5;" + |There are no cancer cells in the [[Lymph node|lymph nodes]]
|-
| style="background:#DCDCDC;" align="center" + |N1
| style="background:#F5F5F5;" + |There are cancer cells in nearby [[Lymph node|lymph nodes]]
|-
| style="background:#DCDCDC;" align="center" + |N2
|There are cancer cells in [[Lymph node|lymph nodes]] further away, such as the chest
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + | M
| style="background:#DCDCDC;" align="center" + |M0
| style="background:#F5F5F5;" + |There is no sign of cancer spread
|-
| style="background:#DCDCDC;" align="center" + |M1
| style="background:#F5F5F5;" + |The cancer has spread to other parts of the body far away from the [[bile duct]]
|-
|}


=== Diagnostic Criteria ===
====Extrahepatic cholangiocarcinoma====
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].


* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
{| class="wikitable" align="right"
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''T'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''N'''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''M'''
|-
| style="background:#DCDCDC;" align="center" + |IA
| style="background:#F5F5F5;" + |T1
| style="background:#F5F5F5;" + |N0
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IB
| style="background:#F5F5F5;" + |T2
| style="background:#F5F5F5;" + |N0
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IIA
| style="background:#F5F5F5;" + |T3
| style="background:#F5F5F5;" + |N0
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IIB
| style="background:#F5F5F5;" + |T1-3
| style="background:#F5F5F5;" + |N1
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |III
| style="background:#F5F5F5;" + |T4
| style="background:#F5F5F5;" + |Any N
| style="background:#F5F5F5;" + |M0
|-
| style="background:#DCDCDC;" align="center" + |IV
| style="background:#F5F5F5;" + |Any T
| style="background:#F5F5F5;" + |Any N
| style="background:#F5F5F5;" + |M1
|}
{| class="wikitable" align="center"
| colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''AJCC 2010'''
|-
! rowspan="5" style="background:#DCDCDC;" align="center" + | T
| style="background:#DCDCDC;" align="center" + | Tis
| style="background:#F5F5F5;" + |The [[tumor]] is only within the top layers of cells lining the bile duct
|-
| style="background:#DCDCDC;" align="center" + |T1
| style="background:#F5F5F5;" + |The [[tumor]] is entirely inside the bile duct but has grown deeper into the bile duct wall
|-
| style="background:#DCDCDC;" align="center" + |T2
| style="background:#F5F5F5;" + |The [[tumor]] has grown through the wall of the bile duct
|-
| style="background:#DCDCDC;" align="center" + |T3
| style="background:#F5F5F5;" + |The [[tumor]] has grown into the gallbladder, pancreas, small bowel or other nearby organs
|-
| style="background:#DCDCDC;" align="center" + |T4
|The [[tumor]] has grown into the major blood vessel in the abdomen (the aorta) where it joins the main blood vessel of the liver (the hepatic artery)
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + | N
| style="background:#DCDCDC;" align="center" + |N0
| style="background:#F5F5F5;" + |There are no cancer cells in the [[Lymph node|lymph nodes]]
|-
| style="background:#DCDCDC;" align="center" + |N1
| style="background:#F5F5F5;" + |There are cancer cells in the [[Lymph node|lymph nodes]]
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + | M
| style="background:#DCDCDC;" align="center" + |M0
| style="background:#F5F5F5;" + |There is no sign of [[cancer]] spread
|-
| style="background:#DCDCDC;" align="center" + |M1
| style="background:#F5F5F5;" + |The cancer has spread to other parts of the body away from the [[bile duct]]
|-
|}


* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
==References==
** Criteria 1
{{reflist|2}}
** Criteria 2
** Criteria 3


IF there are clear, established diagnostic criteria:
[[Category:Disease]]
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
[[Category:Rare cancers]]
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
[[Category:Rare diseases]]
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
[[Category:Types of cancer]]
IF there are no established diagnostic criteria: 
[[Category:Hepatology]]
*There are no established criteria for the diagnosis of [disease name].
[[Category:Gastroenterology]]


==References==
{{Reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]

Latest revision as of 19:52, 17 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

The staging of cholangiocarcinoma varies depending on whether the tumor is primarily intrahepatic (ICC), hilar/perihilar, or extrahepatic.

Diagnostic Study of Choice

The staging of cholangiocarcinoma varies depending on whether the tumor is primarily intrahepatic (ICC), hilar/perihilar, or extrahepatic.[1][2][3][4]

Staging

Intrahepatic cholangiocarcinoma staging

Stage T N M
IA T1 N0 M0
IB T2 N0 M0
IIA T3 N0 M0
IIB T1-3 N1 M0
III T4 Any N M0
IV Any T Any N M1
AJCC 2010
T Tis The tumour is only within the top layers of cells lining the bile duct
T1 There is one tumor that is contained within the bile duct, but has grown deeper into the wall of the bile duct
T2a There is one tumor and it has grown through the wall of the bile duct into a nearby blood vessel
T2b There is more than one tumour which may or may not have grown into a nearby blood vessel
T3  The tumour has either grown into the covering of the liver (the peritoneum) or has grown into nearby structures outside the liver, such as the bowel
T4 The tumour has spread into the liver by growing along the ducts
N N0 There are no cancer cells in the lymph nodes
N1 There are cancer cells in the lymph nodes
M M0 There is no sign of cancer spread
M1 The cancer has spread to other parts of the body away from the bile duct

Perhilar cholangiocarcinoma

Stage T N M
IA T1 N0 M0
IB T2 N0 M0
IIA T3 N0 M0
IIB T1-3 N1 M0
III T4 Any N M0
IV Any T Any N M1
AJCC 2010
T Tis The tumor is only within the top layers of cells lining the bile duct
T1 The tumor has grown deeper into the wall of the bile duct
T2a The tumor has grown through the wall of the bile duct into the fatty tissue around it
T2b The tumor has grown into the main part of the liver next to the bile duct
T3 The tumor has grown into one of the main blood vessels of the liver (the portal vein or hepatic artery)
T4 The tumour has grown into the right and left hepatic bile ducts. Or it has grown into more than one of the blood vessels. Or it has grown into a hepatic bile duct and more than one blood vessel
N N0 There are no cancer cells in the lymph nodes
N1 There are cancer cells in nearby lymph nodes
N2 There are cancer cells in lymph nodes further away, such as the chest
M M0 There is no sign of cancer spread
M1 The cancer has spread to other parts of the body far away from the bile duct

Extrahepatic cholangiocarcinoma

Stage T N M
IA T1 N0 M0
IB T2 N0 M0
IIA T3 N0 M0
IIB T1-3 N1 M0
III T4 Any N M0
IV Any T Any N M1
AJCC 2010
T Tis The tumor is only within the top layers of cells lining the bile duct
T1 The tumor is entirely inside the bile duct but has grown deeper into the bile duct wall
T2 The tumor has grown through the wall of the bile duct
T3 The tumor has grown into the gallbladder, pancreas, small bowel or other nearby organs
T4 The tumor has grown into the major blood vessel in the abdomen (the aorta) where it joins the main blood vessel of the liver (the hepatic artery)
N N0 There are no cancer cells in the lymph nodes
N1 There are cancer cells in the lymph nodes
M M0 There is no sign of cancer spread
M1 The cancer has spread to other parts of the body away from the bile duct

References

  1. ↑ Blechacz B, Komuta M, Roskams T, Gores GJ (2011). "Clinical diagnosis and staging of cholangiocarcinoma". Nat Rev Gastroenterol Hepatol. 8 (9): 512–22. doi:10.1038/nrgastro.2011.131. PMC 3331791. PMID 21808282.
  2. ↑ Patel T (2011). "Cholangiocarcinoma--controversies and challenges". Nat Rev Gastroenterol Hepatol. 8 (4): 189–200. doi:10.1038/nrgastro.2011.20. PMC 3888819. PMID 21460876.
  3. ↑ Groot Koerkamp B, Wiggers JK, Allen PJ, Busch OR, D'Angelica MI, DeMatteo RP, Fong Y, Gonen M, Gouma DJ, Kingham TP, van Gulik TM, Jarnagin WR (2014). "American Joint Committee on Cancer staging for resected perihilar cholangiocarcinoma: a comparison of the 6th and 7th editions". HPB (Oxford). 16 (12): 1074–82. doi:10.1111/hpb.12320. PMC 4253330. PMID 25267346.
  4. ↑ Ronnekleiv-Kelly SM, Pawlik TM (2017). "Staging of intrahepatic cholangiocarcinoma". Hepatobiliary Surg Nutr. 6 (1): 35–43. doi:10.21037/hbsn.2016.10.02. PMC 5332207. PMID 28261593.

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