Focal intrahepatic strictures: A proposal classification based on diagnosis-treatment experience and systemic review

Table 1 Basic clinical data of the patients of focal intrahepatic strictures

No.	Sex	Age	Main symptoms		Bilirubin and ALP before treatment for FIHS		CA199 (ng/mL)	AFP (ng/mL)	History of surgery	Methods for initial diagnosis	Initial diagnosis	Final diagnosis	Location of FIHS	Treatment for FIHS
			Abdominal pain	Fever	T-bil/D-bil (μmol/L)	ALP (U/L)
1	F	65	Mild	-	16.1/0.0	0.0	20.55	8.99	No	MDCT	Suspected ICC	ICC	LLIHD	Left lateral hepatectomy
2	M	70	-	-	16.7/6.2	6.2	13.4	737.00	Yes1	MDCTMRCP	rHCC with BDTT/PVTTLung metastasis	rHCC with BDTT/PVTTLung metastasis	LLIHD	Lenvatinib + Sintilizumab
3	F	60	Mild	-	16.8/8.6	8.6	2270.0	1.61	No	MDCTMRCP	HepatolithiasisSuspected ICC	ASC of liver	LIHD	Left hepatectomy
4	F	67	Mild	-	15.0/0.0	0.0	93.9	2.91	No	USMDCTMRCPERCPSpyglass	Suspected ICC	Hepatolithiasis	LIHD	Left hepatectomy
5	F	49	-	-	21.6/10.4	614.0	11.83	0.90	No	MRCP	Hepatitis	SD-PSC(biopsy)	Multiple IHD	UDCA
6	F	55	-	-	283.5/150.0	279.0	770.0	23.8	No	MDCTMRCPERCP	Suspected PSC	AIH(biopsy)	Multiple IHD	UDCA + MP

¹The patient had histories of hepatectomy for hepatocellular carcinoma (HCC) 19 mo before this admission and resection of the recurrent isolated HCC lesion in abdominal cavity 9 mo before this admission, respectively. T-bil: Total bilirubin; D-bil: Direct bilirubin; ALP: Alkaline phosphatase; AFP: Alpha-fetoprotein; FIHS: Focal intrahepatic strictures; ICC: Intrahepatic cholangiocarcinoma; LLIHD: Left lateral intrahepatic duct; MDCT: Multidetector-row computed tomography; MRCP: magnetic resonance cholangiopancreatography; SD-PSC: small duct primary sclerosing cholangitisprimary; IHD: intrahepatic duct; UDCA: Ursodeoxycholic acid; ASC: Adenosquamous carcinoma; US: Ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography; LIHD: Left intrahepatic duct; rHCC: Recurrent hepatocellular carcinoma; BDTT: Bile duct tumor thrombi; PVTT: Portal vein tumor thrombus; PSC: Primary sclerosing cholangitis; AIH: Autoimmune hepatitis; MP: Methylprednisolone.