Extrahepatic biliary cancer: New staging classification

Table 1 Multidetector computed tomography parameters

Parameter	Value
Detector collimation	0.5 to 0.75
Pitch	0.984
kVp	120
Contrast	125 cc of intravenous optiray 350

Table 2 Multidetector computed tomography multiphasic acquisition

Phase of image acquisition	Time of acquisition	Section thickness (mm)	Milliamperage (mA)
Unenhanced liver images		5	250
Arterial phase liver images	Bolus tracking technique or manually at 30-35 s after the onset of contrast material injection	1-2.5	500
Portal venous phase abdomen and pelvis	Acquired 60-65 s after the start of injection	2.5-5	500
Delayed phase	Acquired 3-5 min after the start of injection	5	250

2.5-mm thick coronal and sagittal reformats are reconstructed with images of the portal venous phase.

Table 3 Magnetic resonance imaging protocol

Entry	Feet first			Position	Supine
Coil type	8 cardiac or 8 body upper	8 cardiac or 8 body upper	8 cardiac or 8 body upper	8 cardiac or 8 body upper	8 cardiac or 8 body upper	8 cardiac or 8 body upper	8 cardiac or 8 body upper
Series desc	(1) Axial T2	(2) ASSET calib	(3) Axial T1 asset	(4) 3D LAVA XV Dyn	(5) Diffusion	(6) 3D 5 min LAVA XV	(7) Fiesta
Scan plane	Axial	Axial	Axial pre	Axial	Axial	Axial	Coronal
Image mode	2D	2D	2D in/out phase	3D	2D	3D	2D
Pulse seq	FSE-XL	Fast SPGR	Fast SPGR	Fast SPGR	DW EPI	Fast SPGR	Fiesta
TE1/TE2 (ms)	85		FWIP/FWOP	Min Full	Min (~ 50-60)		Min
TR/#R-R (ms)	4000-6000		150-220		1200-1800
Flip angle			85	15	NA	15	50-75
ETL (echo train length)	16
RCV BW1 (kHz)	41.67		62.50	83.33	(125)	83.33	83-125
FOV (cm)	34-44	48	34-44	34-42	38-44	34-44	34-44
SCAN THK (mm)	6	10	5	4	5	4	5
Spacing/#Loc	0	0	0	-2.0	0/36 slices	-2.0	0 or -1
Freq × phase	256 × 192		256 × 192	320 × (160-192)	100 × 160	320 × (160-192)	192 × 356
NEX	3-4	1	1		6		2
Phase FOV	0.75-1.0	1.0	0.9-1.0	0.75-1.0	1.0	0.70-0.90	0.75 –1.0
Freq dir	R/L	A/P	R/L	R/L	R/L	R/L	S/I

Table 4 Extrahepatic bile duct tumors (American Joint Commission on Cancer staging 6th edition)

Tumor	TNM classification
T1	Tumor confined to bile duct histologically
T2	Tumor beyond the wall of bile duct
T3	Tumor invades liver, GB, pancreas, and/or ipsilateral PV (R or L) or hepatic artery (R or L)
T4	Tumor invades main portal vein or its branches bilaterally, common hepatic artery, or adjacent structures (colon, stomach, duodenum, abdominal wall)
Node
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis (including hilar, celiac, superior mesenteric, periduodenal and peripancreatic)
Metastasis
M0	No distant metastasis
M1	Distant metastasis
Tumor stage	AJCC staging 6th edition
Stage IA	T1, N0, M0
Stage IB	T2, N0, M0
Stage IIA	T3, N0, M0
Stage IIB	T1 or T2 or T3, N1, M0
Stage III	T4, any N, M0
Stage IV	Any T, any N, M1

T: Tumor; N: Node; M: Metastases; GB: Gallbladder; PV: Pulmonary vein; AJCC: American Joint Commission on Cancer.

Table 5 Perihilar bile duct tumors (American Joint Commission on Cancer staging 7th edition)

Tumor	TNM classification
T1	Tumor confined to bile duct histologically
T2a	Tumor beyond the wall of bile duct into adjacent fat
T2b	Tumor beyond the wall of bile duct into liver parenchyma
T3	Tumor invades ipsilateral portal vein (R or L) or hepatic artery (R or L)
T4	Tumor invades
	(1) Main portal vein or its branches bilaterally (or)
	(2) Common hepatic artery (or)
	(3) The second-order biliary radicals bilaterally
	(4) Unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement
Node
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis (including nodes along the cystic duct, common bile duct, hepatic artery, and portal vein)
N2	Metastasis to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes
Metastasis
M0	No distant metastasis
M1	Distant metastasis
Tumor stage	AJCC staging 6th edition
Stage I	T1, N0, M0
Stage II	T2a-b, N0, M0
Stage IIIA	T3, N0, M0
Stage IIIB	T1 or T2 or T3, N1, M0
Stage IVa	T4, N0 or N1, M0
Stage IVb	Any T, N2, M0 or any T, any N, M1

T: Tumor; N: Node; M: Metastases; GB: Gallbladder; PV: Pulmonary vein; AJCC: American Joint Commission on Cancer.

Table 6 Distal bile duct tumors (American Joint Commission on Cancer staging 7th edition)

Tumor	TNM classification
T1	Tumor confined to bile duct histologically
T2	Tumor beyond the wall of bile duct
T3	Tumor invades liver, GB, pancreas, but no involvement of celiac axis, or the superior mesenteric artery
T4	Tumor involves the celiac axis, or the superior mesenteric artery
Node
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis (including hilar, celiac, superior mesenteric, periduodenal and peripancreatic)
Metastasis
M0	No distant metastasis
M1	Distant metastasis
Tumor stage	AJCC staging 6th edition
Stage IA	T1, N0, M0
Stage IB	T2, N0, M0
Stage IIA	T3, N0, M0
Stage IIB	T1 or T2 or T3, N1, M0
Stage III	T4, any N, M0
Stage IV	Any T, any N, M1

T: Tumor; N: Node; M: Metastases; GB: Gallbladder; PV: Pulmonary vein; AJCC: American Joint Commission on Cancer.