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Preoperative Imaging

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Hilar Cholangiocarcinoma

Abstract

Cholangiocarcinomas (CC) are relatively rare tumors, although their incidence is increasing worldwide [1]. CC is classified anatomically as intrahepatic (5–10 % of cases), perihilar (60–70 %), or distal (20–30 %) [2, 3]. Hilar cholangiocarcinoma(HCCA) originally described by Klatskin, is defined as adenocarcinoma of the extrahepatic biliary tree, arising from the biliary confluence and/or the main left or right hepatic ducts, whereas intrahepatic CC arises from the bile ducts peripheral to the secondary bifurcation of the left or right hepatic duct [4, 5]. Cancers arising in the perihilar region have been further classified according to the pattern of involvement of the hepatic ducts (the Bismuth-Corlette classification) (Fig. 5.1) [6]. Despite a great increase in knowledge and major improvements in diagnostic methods as well as surgical techniques, these tumors still are a problematic issue [7]. Preoperative histological confirmation of an HCCA can be difficult to obtain. Percutaneous needle biopsies and endoscopic brush biopsies are reliable only if they identify a malignancy (sensitivity, 50 %), and excessive reliance on negative results may miss the opportunity to resect an early lesion [8, 9]. Whereas the vast majority of hilar strictures are the result of an HCCA, histological diagnosis is not mandatory before exploration. Accurate detection and differentiation from other bile duct pathologies on imaging, such as inflammatory lesions or stone disease, are highly important [7].

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  1. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    B. I. Choi MD & J. M. Lee MD

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    W.Y. Lau

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Choi, B.I., Lee, J.M. (2013). Preoperative Imaging. In: Lau, W. (eds) Hilar Cholangiocarcinoma. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6473-6_5

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