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Advances in Radiotherapy
& Nuclear Medicine Diagnostics gude of biliary tract cancer

Table 2. Characteristics of common diagnostic methods for biliary tract cancer
Ultrasonography CT MRI Positron emission Endoscopic US Direct
tomography cholangiography
Enables Used to assess and MRI combined with Now considered the Enables accurate Essential in the
confirmation determine the stage of magnetic resonance standard method assessment of the evaluation and
of biliary tract advancement of bile duct cholangiopancreatography for staging various extrahepatic bile ducts, treatment of CCA,
dilatation and cancer is optimal for assessing the malignancies and has gallbladder, liver hilum often serving as
exclusion of bile ducts both above and also proven useful in the structures, regional a crucial tool for
gallstones and liver below their strictures diagnosis and staging of lymph nodes, and diagnosis
masses biliary tract cancer vessels
Useful for the Characterized by high Useful for confirming or Its sensitivity and Tumor detection Determines the
initial assessment spatial and temporal establishing the diagnosis, specificity ranges are rate of 94% in CCA anatomy of the bile
of tumor masses in resolution as well as assessing the the broadest among all patients ducts and allows
the bile ducts and possibility of resection and diagnostic methods for biopsy or smear
gallbladder differential diagnosis test from the site of
damage
Facilitates easy More accurate than an Its usage alone is Sensitivity drops to Can assess the status Functions as a
visualization of ultrasound insufficient to determine 12% and specificity to of regional lymph therapeutic tool for
papillary tumors the correct surgical strategy 96% when assessing nodes and the local dilating and placing
and nodular ductal metastases to regional extent of extrahepatic stents in biliary tract
carcinomas of the lymph nodes cholangiocarcinoma strictures
biliary tract
Accuracy ranges Performed in 90% of Has the best sensitivity PET-based radiomics The information Particularly useful
from 87% to 96% patients with suspected bile (92%) and specificity (76%) of iCCA can predict obtained can be used in determining
duct cancer compared to CT pathological findings to guide patient care the stage of cancer
and enable reliable and improve outcomes progression and the
pre-operative prognostic extent of extrahepatic
assessment and perihepatic
lesion invasion
Can be used to Characterized by relatively Allows examination of
guide needle low sensitivity (61%) all relevant structures,
biopsy of and specificity (88%) in including the bile
intrahepatic detecting lymph node ducts, vessels, and liver
lesions metastases parenchyma
Abbreviations: CCA: Cholangiocarcinoma; CT: Computed tomography; EUS: Endoscopic ultrasound; MRI: Magnetic resonance imaging;
PET: Positron emission tomography; US: Ultrasound; iCCA: Intrahepatic cholangiocarcinoma.

complication rates. Digital cholangioscopy is regarded as surgical planning. Digital cholangioscopy provides a safe
a safe and effective complement to standard ERCP, with and effective method for pre-operative assessment of the
advancements in digital technology addressing many extent of biliopancreatic neoplasia, including surgical
of the limitations observed in earlier generations of decisions in a considerable number of cases. 108
cholangioscopes. 107 Gene panel testing, in combination with advanced
Digital cholangioscopy provides high-quality, direct genomic mutation analysis using next-generation
visualization of biliary lesions and enables precise, targeted sequencing (NGS) or similar technologies, enables the
biopsies. Key cholangioscopic features suggestive of simultaneous detection of multiple genomic alterations.
malignancy include dilated, tortuous tumor vessels, infiltrative These methods are essential for identifying cancer-related
strictures with irregular margins and partial lumen occlusion, mutations in individual patients and facilitating the
an uneven surface, and areas prone to easy bleeding. development of personalized treatment plans. Typically, a
An emerging application of digital cholangioscopy is gene panel test focuses on a selection of genes that are critical
the mapping of biliopancreatic neoplasia. This technology for predicting responses to medication and prognosis,
allows for the precise visual delineation of neoplastic thereby aiding in more accurate medical diagnoses.
margins within the biliary and pancreatic ducts, thereby These panels can assess a wide range of genomic
improving the accuracy of malignancy staging. As a result, alterations, including mutations, deletions, insertions, gene
enhanced visualization can significantly impact and alter fusions, and duplications, by analyzing multiple transcripts

Volume 3 Issue 1 (2025) 9 doi: 10.36922/arnm.4557