Childers Betzaira G, Denbo Jason W, Kim Richard D, Hoffe Sarah E, Glushko Tetiana, Qayyum Aliya, Anaya Daniel A
Moffitt Cancer Center, Tampa, USA.
Abdom Radiol (NY). 2025 Mar 17. doi: 10.1007/s00261-025-04856-5.
Cholangiocarcinoma (CCA) is a unifying title granted to epithelial adenocarcinomas specific to the bile ducts making up 10-25% of all hepatobiliary malignancies. CCA is more appropriately classified based on anatomic site of origin within the biliary tract into intrahepatic cholangiocarcinoma (iCCA), peri-hilar (pCCA) cholangiocarcinoma, and distal cholangiocarcinoma (dCCA). Intrahepatic cholangiocarcinoma makes up 10-20% of CCA and originates within and/or proximal to the second order bile ducts. The incidence of iCCA has been rising overtime with up to 1.26 per 100,000 persons, per year in the United States and up to 3.3 per 100, 000 persons, per year affected globally. Risk factors include chronic hepatic inflammation secondary to viral hepatitis, alcohol/NASH cirrhosis, biliary cystic lesions, and endemic causes, among other less common genetic drivers. Given its rarity, the recognition and diagnosis of cholangiocarcinoma, iCCA specifically, remains challenging resulting in delays in treatment initiation or any treatment at all. Median overall survival (mOS) for iCCA remains low. Early diagnosis, and stage-based treatment approaches have evolved and are associated with improved survival. To this goal, a multi-disciplinary treatment approach has been demonstrated to improve patient outcomes by providing expert evaluation as it pertains to an accurate imaging and histologic diagnosis, staging, radiologic and surgical review for resectability, operative expertise, post operative care, as well as comprehensive knowledge and implementation of systemic/targeted or liver directed therapies. Here, we discuss the central role of imaging in the diagnosis of intrahepatic cholangiocarcinoma to implement a comprehensive treatment plan that frequently involves multiple disciplines to achieve the best outcome for each patient.
胆管癌（CCA）是一个统一的名称，用于指特定于胆管的上皮腺癌，占所有肝胆恶性肿瘤的10%-25%。根据胆管内的起源解剖部位，CCA更合适地分为肝内胆管癌（iCCA）、肝门周围（pCCA）胆管癌和远端胆管癌（dCCA）。肝内胆管癌占CCA的10%-20%，起源于二级胆管内和/或二级胆管近端。在美国，iCCA的发病率一直在上升，每年每10万人中高达1.26例，全球每年每10万人中高达3.3例。危险因素包括病毒性肝炎继发的慢性肝脏炎症、酒精性/非酒精性脂肪性肝炎肝硬化、胆管囊性病变和地方病病因，以及其他不太常见的基因驱动因素。由于其罕见性，胆管癌（特别是iCCA）的识别和诊断仍然具有挑战性，导致治疗开始延迟或根本无法进行任何治疗。iCCA的中位总生存期（mOS）仍然很低。早期诊断和基于分期的治疗方法已经发展，并且与生存率的提高相关。为了实现这一目标，多学科治疗方法已被证明可以通过提供专家评估来改善患者预后，这些评估涉及准确的影像学和组织学诊断、分期、可切除性的放射学和手术评估、手术专业知识、术后护理，以及全身/靶向或肝导向治疗的全面知识和实施。在此，我们讨论影像学在肝内胆管癌诊断中的核心作用，以实施一个通常涉及多个学科的综合治疗计划，为每个患者实现最佳结果。
