Liver Unit, Division of Digestive Diseases, Imperial College London and Imperial College Healthcare NHS Trust, UK.
Aintree University Hospital Foundation Trust, UK.
Eur J Surg Oncol. 2021 Mar;47(3 Pt B):635-639. doi: 10.1016/j.ejso.2020.09.039. Epub 2020 Oct 1.
Cholangiocarcinoma (CCA) are sub-divided into intrahepatic (iCCA) or extrahepatic (eCCA). eCCA are further subdivided into perihilar (pCCA) and distal (dCCA). Current and previous versions of the WHO International Coding of Disease and Oncology classifications (ICD) have separate topography codes for iCCA and eCCA, but none for pCCA. Over recent decades, multiple studies report rising incidence rates of iCCA with declining rates of eCCA, without reference to pCCA. We hypothesised the lack of a specific code for pCCA has led to errors CCA coding, specifically with miscoding of pCCA as iCCA.
Clinical notes of cases coded as hepatobiliary carcinoma using ICD-10 criteria (C22.1/Intrahepatic Bile Duct carcinoma, C24.0/Extrahepatic Bile Duct carcinoma, C23X/Malignant Neoplasm Gall Bladder, C22.0/Malignant Neoplasm Liver Cell Carcinoma) over a 2 year period (2015-2017), were reviewed by two independent clinicians at three independent UK regional HepatoPancreatoBiliary centres. The agreed final diagnosis was compared to the originally allocated ICD-10 code.
Of the 625 CCA cases fully reviewed, 226 were coded as C22.1/iCCA. 98 (43%) of these were true iCCA and coded correctly, while 76 cases (34%) were actually pCCA. 92% all pCCA cases were incorrectly coded as iCCA.
CCA coding misclassification in UK HPB centres is common, particularly the miscoding of pCCA, which is extrahepatic and the commonest form of CCA, as iCCA. This may be contributing to apparent rising incidence rates of iCCA. Our findings confirm the need to implement distinct topographical codes for iCCA, pCCA and dCCA in future iterations of ICD.
胆管癌（CCA）可分为肝内（iCCA）或肝外（eCCA）。eCCA 进一步分为肝门部（pCCA）和远端（dCCA）。世界卫生组织（WHO）国际疾病分类和肿瘤学分类（ICD）的现行和以前版本为 iCCA 和 eCCA 分别提供了单独的解剖学编码，但 pCCA 没有。最近几十年，多项研究报告称 iCCA 的发病率上升，而 eCCA 的发病率下降，而没有提到 pCCA。我们假设缺乏 pCCA 的特定编码导致了 CCA 编码错误，特别是将 pCCA 错误编码为 iCCA。
在两年期间（2015-2017 年），使用 ICD-10 标准（C22.1/肝内胆管癌、C24.0/肝外胆管癌、C23X/胆囊恶性肿瘤、C22.0/肝细胞癌恶性肿瘤）对编码为肝胆癌的病例的临床记录进行了回顾，由三家英国区域肝胆胰中心的两位独立临床医生进行。将最终诊断与最初分配的 ICD-10 编码进行比较。
在对 625 例 CCA 病例进行全面审查后，有 226 例被编码为 C22.1/iCCA。其中 98 例（43%）为真正的 iCCA，编码正确，而 76 例（34%）实际上为 pCCA。所有 pCCA 病例中有 92%被错误编码为 iCCA。
英国 HPB 中心的 CCA 编码分类错误很常见，特别是 pCCA 的分类错误，因为 pCCA 是肝外的，也是最常见的 CCA 类型，被错误编码为 iCCA。这可能是 iCCA 发病率上升的原因之一。我们的发现证实了在 ICD 的未来迭代中为 iCCA、pCCA 和 dCCA 实施不同的解剖学编码的必要性。
