Detection of Tumor Multifocality in Resectable Intrahepatic Cholangiocarcinoma: Defining the Optimal Pre-operative Imaging Modality

Thomas L. Sutton, Kevin Billingsley, Brett S. Walker, Alice W. Fung, Erin Maynard, C. Kristian Enestvedt, Elizabeth N. Dewey, Brian T. Brinkerhoff, Charles D. Lopez, Susan L. Orloff, Skye C. Mayo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Multiple tumor foci (MTF) in intrahepatic cholangiocarcinoma (ICC), including satellitosis and true multifocality, is a known negative prognostic factor and can inform pre-operative decision-making. Lack of standardized pre-operative liver staging practices may contribute to undiagnosed MTF and poor outcomes. We sought to investigate the sensitivity of different cross-sectional imaging modalities for MTF at our institution. Methods: We identified n = 52 patients with ICC who underwent curative-intent resection from 2004 to 2017 in a multidisciplinary hepato-pancreato-biliary cancer program. Timing and modality of pre-operative imaging were recorded. Blinded review of imaging was performed and modalities were evaluated for false-negative rate (FNR) in detecting MTF, satellitosis, and true multifocality. Results: Forty-one (79%) patients underwent CT and 20 (38%) underwent MRI prior to hepatectomy. MTF was pre-operatively identified in six (12%) patients. An additional seven patients had MTF discovered on final surgical pathology, despite a median interval from CT/MRI to surgery of 20 days. On blinded review the FNR of MRI compared to CT for multifocality was 0% vs. 38%, 50% vs 80% for satellitosis, and 22% vs 46% for MTF as a whole. Conclusion: CT is inadequate for pre-operative diagnosis of MTF in resectable ICC, even when performed within 30 days of hepatectomy. We recommend liver-protocol MRI as the standard pre-operative imaging modality in non-metastatic ICC.

Original languageEnglish (US)
Pages (from-to)2250-2257
Number of pages8
JournalJournal of Gastrointestinal Surgery
Issue number9
StatePublished - Sep 2021


  • Detection
  • Intrahepatic cholangiocarcinoma
  • Pre-operative imaging
  • Tumor multifocality

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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