Early bile duct cancer

Table 1 Publications on early bile duct cancers

Author	Yr	Depth of invasion		Number of early cancer	Total number of cholangiocarcinoma
		Mucosa	Fibromuscular
Tsunoda et al[5]	1989	3	5	8 (6%)	146
Yamaguchi[6]	1992		NC	7	NM
Mizumoto et al[7]	1993	4	10	14 (8%)	171
Bhuiya et al[8]	1993		NC	7 (10%)	70
Kurosaki et al[9]	1998		NC	7 (8%)	90
Tamada et al[10]	2001		NC	10 (18%)	55
Lim et al[11]	2006	11	10	23 (3%)1	742
Cha et al[4]	2006	16	45	61 (10%)	614

NC: not classified; NM: not mentioned.

¹Two cases were not included in the evaluation of depth of invasion.

Table 2 Suggested definition for early bile duct cancer

Bile duct cancer whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement

Table 3 Changes in T classification of the AJCC staging for extrahepatic bile duct cancer

AJCC 5th edition[21]		AJCC 6th edition[22]
pT	Tumor invasion	pT	Tumor invasion
T1a	Subepithelial connective tissue	T1	Confined to the bile duct
T1b	Fibromuscular layer	T2	Beyond the bile duct wall
T2	Perifibromuscular connective tissue	T3	Liver, gallbladder, pancreas
T3	Liver, pancreas, gallbladder, stomach, duodenum, colon	T4	Duodenum, colon, stomach, abdominal wall

AJCC: American Joint Committee on Cancer.

Table 4 Changes in T classification of the AJCC staging for intrahepatic bile duct cancer

pT	AJCC 5th edition[21]	AJCC 6th edition[22]
T1	Solitary, ≤ 2 cm, without vascular invasion	Solitary, without vascular invasion
T2	Solitary, ≤ 2 cm with vascular invasion or multiple, one lobe, ≤ 2 cm without vascular invasion	Ssolitary, with vascular invasion or multiple ≤ 5 cm
T3	Solitary, > 2 cm with vascular invasion or multiple, one lobe, ≤ 2 cm, with vascular invasion	Multiple ≥ 5 cm or major portal/hepatic vein branch
T4	Multiple, more than one lobe or major portal/hepatic vein branch	Adjacent organ or perforation of viscera

Table 5 Clinical characteristics of early bile duct cancer patients[4]

Characteristics	Intrahepatic EBDC	Extrahepatic EBDC	Total
Number of patients	23	38	61
Demographic data
Age (yr)	59 ± 2	60 ± 2	59 ± 1
Gender (male:female)	13:10	31:7	44:17
Chief complaints
Asymptomatic	14 (23%)	10 (16%)	24 (39%)
Jaundice	0	10 (16%)	10 (16%)
Abdominal pain	4 (7%)	5 (8%)	9 (15%)
Dyspepsia	3 (5%)	3 (5%)	6 (10%)
Others	2 (3%)	10 (16%)	12 (19%)
Associated disease
Hepatolithiasis	9 (15%)	2 (3%)	11 (18%)
Clonorchiasis	4 (7%)	4 (7%)	8 (14%)
Biliary papillomatosis	10 (16%)	7 (12%)	17 (28%)
Choledochal cyst ± AUPBD	5 (8%)	6 (10%)	11 (18%)

EBDC: early bile duct cancer; AUPBD: anomalous union of pancreaticobiliary ducts.

Table 6 Macroscopic classification of early bile duct cancer

	IG type	PI type	MF type	Total
Cha et al[4]	35 (57%)	17 (28%)	1 (2%)	611
Tsunoda et al[5]	7 (88%)	1 (13%)	0	8
Yamaguchi[6]	7 (100%)	0	0	7
Mizumoto et al[7]	10 (71%)	3 (21%)	1 (7%)	14
Tamada et al[10]	8 (80%)	0	2 (20%)	10
Lim et al[11]	10 (47%)	1 (5%)	2 (10%)	21
Kozuka et al[36]	7 (54%)	5 (39%)	1 (8%)	13

IG: intraductal-growing; PI: periductal-infiltrating; MF: mass-forming.

¹Eight patients could not be classified into any types due to subtle gross changes.

Table 7 Microscopic classifications and locoregional extensions in early bile duct cancer

	Microscopic classification			Locoregional extensions
	Adenoca	Papillary ca	Others	LV (+)	PN (+)	LN (+)
Cha et al[4] (n = 61)	41(67%)	19 (31%)	1 (2%)	4 (7%)	5 (8%)	1 (2%)
Yamaguchi[6] (n = 7)	3 (43%)	4 (57%)	0	0	0	0
Mizumoto et al[7] (n = 14)	6 (43%)	8 (57%)	0	1 (7%)	0	0
Kurosaki et al[9] (n = 7)		NM		2 (29%)	0	0
Tamada et al[10] (n = 10)	1 (10%)	9 (90%)	0		NM
Lim et al[11] (n = 21)	6 (29%)	13 (62%)	2 (10%)	0	0	1 (5%)
Kozuka et al[36] (n = 13)	3 (23%)	10 (77%)	0		NM

Ca: carcinoma; LV (+): lymphovascular invasion; PN (+): perineural infiltration; LN (+): lymph node metastasis; NM: not mentioned.