Algorithm for the Diagnosis of Perihilar Cholangiocarcinoma - Flowchart
Algorithm for the Diagnosis of Perihilar Cholangiocarcinoma - Flowchart Cholangiocarcinoma Cholangiocarcinoma
«Flowchart»

Clinical suspicion of cholangiocarcinoma

Clinical suspicion of cholangiocarcinoma

Clinical suspicion of cholangiocarcinoma

Clinical suspicion of cholangiocarcinoma

Observation

Observation

Observation

Observation

Management of cholangiocarcinoma

Management of cholangiocarcinoma

Management of cholangiocarcinoma

Management of cholangiocarcinoma

End

End

End

End

MRI

MRI

MRI

MRI

Mass vascular encasement

Mass vascular encasement

Mass vascular encasement

Mass vascular encasement

Negative

Negative

Negative

Negative

Significant concern

Significant concern

Significant concern

Significant concern

Minimal concern

Minimal concern

Minimal concern

Minimal concern

PET

PET

PET

PET

"Hot spot"

"Hot spot"

"Hot spot"

"Hot spot"

Negative

Negative

Negative

Negative

Serum CA 19-9 level
ERCP with brush cytology, FISH, DIA

Serum CA 19-9 level
ERCP with brush cytology, FISH, DIA

Serum CA 19-9 level
ERCP with brush cytology, FISH, DIA

Serum CA 19-9 level
ERCP with brush cytology, FISH, DIA


Dominant stricture plus at least one of the following:


CA 19-9 >129 U/ml
Pos. biopsy, cytology, or FISH polysomy

Dominant stricture plus at least one of the following:


CA 19-9 >129 U/ml
Pos. biopsy, cytology, or FISH polysomy

Dominant stricture plus at least one of the following:


CA 19-9 >129 U/ml
Pos. biopsy, cytology, or FISH polysomy


CA 19-9 >129 U/ml
Pos. biopsy, cytology, or FISH polysomy Dominant stricture

Indeterminate results

Indeterminate results

Indeterminate results

Indeterminate results

CA 19-9 <129 U/ml
No dominant stricture
Neg. biopsy, cytology, FISH

CA 19-9 <129 U/ml
No dominant stricture
Neg. biopsy, cytology, FISH

CA 19-9 <129 U/ml
No dominant stricture
Neg. biopsy, cytology, FISH



CA 19-9 <129 U/ml