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المصدر: American Journal of Roentgenology. 214:885-892
مصطلحات موضوعية: Adult, Male, Thyroid nodules, medicine.medical_specialty, Biopsy, Malignancy, Risk Assessment, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, medicine, Humans, Radiology, Nuclear Medicine and imaging, Diagnosis, Computer-Assisted, Thyroid Neoplasms, Thyroid Nodule, Thyroid cancer, Aged, Retrospective Studies, Ultrasonography, Aged, 80 and over, business.industry, Thyroid, Echogenicity, Nodule (medicine), General Medicine, Middle Aged, medicine.disease, Triage, medicine.anatomical_structure, Computer-aided diagnosis, 030220 oncology & carcinogenesis, Female, Radiology, medicine.symptom, business
الوصف: OBJECTIVE. The purpose of this study was to explore whether a quantitative framework can be used to sonographically differentiate benign and malignant thyroid nodules at a level comparable to that of experts. MATERIALS AND METHODS. A dataset of ultrasound images of 92 biopsy-confirmed nodules was collected retrospectively. The nodules were delineated and annotated by two expert radiologists using the standardized Thyroid Imaging Reporting and Data System lexicon of the American College of Radiology. In the framework studied, quantitative features of echogenicity, texture, edge sharpness, and margin curvature properties of thyroid nodules were analyzed in a regularized logistic regression model to predict malignancy of a nodule. The framework was validated by leave-one-out cross-validation technique, and ROC AUC, sensitivity, and specificity were used to compare with those obtained with six expert annotation-based classifiers. RESULTS. The AUC of the proposed method was 0.828 (95% CI, 0.715-0.942), which was greater than or comparable to that of the expert classifiers, for which the AUC values ranged from 0.299 to 0.829 (p = 0.99). Use of the proposed framework could have avoided biopsy of 20 of 46 benign nodules in a curative strategy (at sensitivity of 1, statistically significantly higher than three expert classifiers) or helped identify 10 of 46 malignancies in a conservative strategy (at specificity of 1, statistically significantly higher than five expert classifiers). CONCLUSION. When the proposed quantitative framework was used, thyroid nodule malignancy was predicted at the level of expert classifiers. Such a framework may ultimately prove useful as the basis for a fully automated system of thyroid nodule triage.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0c24fb2f865dd0a9b8d7c6e42c7fb6f5
https://doi.org/10.2214/ajr.19.21350 -
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المصدر: Biomedical Journal, Vol 43, Iss 2, Pp 189-194 (2020)
Biomedical Journalمصطلحات موضوعية: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Lung Neoplasms, External auditory canal (EAC), Adenoid cystic carcinoma, medicine.medical_treatment, Perineural invasion, Malignancy, Disease-Free Survival, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Treatment outcome, Pathological, lcsh:QH301-705.5, Aged, Adenoid cystic carcinoma (ACC), lcsh:R5-920, Lung, Clinical characteristics, business.industry, General Medicine, Middle Aged, Prognosis, medicine.disease, Carcinoma, Adenoid Cystic, Survival Rate, Radiation therapy, 030104 developmental biology, medicine.anatomical_structure, lcsh:Biology (General), 030220 oncology & carcinogenesis, Female, Original Article, Radiology, Neoplasm Recurrence, Local, Presentation (obstetrics), Differential diagnosis, business, Otalgia, lcsh:Medicine (General), Ear Canal
الوصف: Background This study reviewed the clinical manifestations, pathological findings, and treatment outcomes of adenoid cystic carcinoma (ACC) in the external auditory canal (EAC). Methods This was a retrospective review of 12 patients with a diagnosis of ACC in the EAC seen in a single institution over a 30-year period. Data on the demographics, clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed. Results The male-to-female ratio was 1:3 and the mean patient age was 55.9 years. The most common clinical presentation was otalgia (75%). Ten patients underwent surgical interventions, including radical mastoidectomy in five patients, wide excision in three, and lateral temporal bone resection in two. Adjuvant radiotherapy or concurrent chemoradiotherapy (CCRT) was performed in case of incomplete resection. Two patients underwent non-surgical treatments: radiotherapy in one and CCRT in the other. Microscopic perineural invasion was not associated with otalgia or histological subtype. The mean follow-up period was 84.6 months. Local recurrence occurred in 33% of patients. One-quarter of patients had distant metastasis, and all had lung metastasis. The 5-year overall survival rate for these patients was 82.5%. Conclusion EAC ACC should be included in the differential diagnosis when a patient presents with otalgia and a mass in EAC for more than 6 months, particularly if the patient is a middle-aged female. Otalgia might not be associated with perineural invasion or histological subtype. The lung is the most common site of distant metastasis in patients with EAC ACC. Further studies should determine the optimal treatment protocol for this rare malignancy.
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المؤلفون: Gevork A. Katanyan, Yulia A Veryaskina, Sergei A Lukyanov, Sergei V Sergiyko, Mikhail K. Ivanov, S. E. Titov, P. S. Demenkov
المصدر: Journal of Clinical Pathology. 73:722-727
مصطلحات موضوعية: Adult, Male, Thyroid nodules, medicine.medical_specialty, Cytodiagnosis, Biopsy, Fine-Needle, Thyroid Gland, 030209 endocrinology & metabolism, Real-Time Polymerase Chain Reaction, Malignancy, Sensitivity and Specificity, Pathology and Forensic Medicine, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Fine needle aspiration cytology, Neoplasms, Cytology, medicine, Humans, RNA, Messenger, Thyroid Neoplasms, Thyroid Nodule, Thyroid cancer, Aged, business.industry, HMGA2 Protein, General Medicine, Middle Aged, medicine.disease, Predictive value, MicroRNAs, 030220 oncology & carcinogenesis, Preoperative Period, Feasibility Studies, Female, Radiology, Differential diagnosis, business, Indeterminate, Algorithms
الوصف: AimsAnalysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Previously, we have developed an algorithm for the differential diagnosis of thyroid nodules by means of a small set of molecular markers. Here, we aimed to validate this approach using FNA cytology samples of Bethesda categories III and IV, in which preoperative detection of malignancy by cytological analysis is impossible.MethodsA total of 122 FNA smears from patients with indeterminate cytology (Bethesda III: 13 patients, Bethesda IV: 109 patients) were analysed by real-time PCR regarding the preselected set of molecular markers (the BRAF V600E mutation, normalised concentrations of HMGA2 mRNA, 3 microRNAs, and the mitochondrial/nuclear DNA ratio). The decision tree–based classifier was used to discriminate between benign and malignant tumours.ResultsThe molecular testing detected malignancy in FNA smears of indeterminate cytology with 89.2% sensitivity, 84.6% positive predictive value, 92.9% specificity and 95.2% negative predictive value; these characteristics are comparable with those of more complicated commercial tests. Residual risk of malignancy for the thyroid nodules that were shown to be benign by this molecular method did not exceed the reported risk of malignancy for Bethesda II histological diagnosis. Analytical-accuracy assessment revealed required nucleic-acid input of ≥5 ng.ConclusionsThe study shows feasibility of preoperative differential diagnosis of thyroid nodules of indeterminate cytology using a small panel of molecular markers of different types by a simple PCR-based method using stained FNA smears.
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المؤلفون: Massimo Terzolo, Enrico Bollito, Anna Pia, E Ingargiola, Soraya Puglisi, Giuseppe Reimondo, A Müller, F. Solitro
المصدر: Journal of Endocrinological Investigation. 43:1301-1307
مصطلحات موضوعية: Male, Adrenal tumor, medicine.medical_specialty, Lung Neoplasms, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Adrenal Gland Neoplasms, Uptake, 030209 endocrinology & metabolism, Malignancy, Metastasis, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Fluorodeoxyglucose F18, Carcinoma, Non-Small-Cell Lung, Carcinoma, medicine, Humans, Lung cancer, Incidentaloma, medicine.diagnostic_test, business.industry, Follow-up, Adrenalectomy, Cancer, Middle Aged, medicine.disease, Magnetic Resonance Imaging, PET, Positron emission tomography, Positron-Emission Tomography, 030220 oncology & carcinogenesis, Radiology, Tomography, X-Ray Computed, business
الوصف: Up to 70% of adrenal masses detected in patients affected by extra-adrenal malignancy are metastatic lesions. Therefore, detection of an adrenal mass in patients with active or previous malignancy requires a careful differential diagnostic workup. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is increasingly being used to determine the malignant potential of adrenal lesions. We report the case of a 64-year-old man who had a single adrenal metastasis due to non-small-cell lung carcinoma developing on a pre-existing benign adrenal lesion. This metastasis occurred in a phase of perceived oncological remission and was detected thanks to 18F-FDG-PET/CT showing a focal adrenal uptake. Contrast-enhanced computed tomography (CT), performed as part of oncological follow-up, and MRI with chemical shift sequences did not lead to the correct diagnosis. The patient underwent laparoscopic adrenalectomy and the pathological evaluation confirmed a lung carcinoma metastasis. The present case highlights the peculiarity of the follow-up of adrenal masses in cancer patients and the primary role of 18F-FDG-PET/CT in the management of such patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a506426cfd857d0177df726b21d55c3a
https://doi.org/10.1007/s40618-020-01219-3 -
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المؤلفون: Mohammed Atieh, Razvan Lapadat, Safa Alshaikh, Eva M. Wojcik, Stefan E. Pambuccian, Swati Mehrotra, Güliz A. Barkan
المصدر: Cancer Cytopathology. 128:384-391
مصطلحات موضوعية: Cancer Research, medicine.medical_specialty, Cytodiagnosis, 030209 endocrinology & metabolism, Malignancy, Sensitivity and Specificity, Stain, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Cytology, Biomarkers, Tumor, Humans, Malignant cells, Medicine, Practice Patterns, Physicians', Medical diagnosis, Retrospective Studies, Body fluid, Pathology, Clinical, Staining and Labeling, business.industry, Reproducibility of Results, medicine.disease, Immunohistochemistry, Body Fluids, Pathologists, Oncology, 030220 oncology & carcinogenesis, Radiology, business
الوصف: Background Body fluid cytology (BFC) is an important tool in the diagnosis and staging of malignancy and is aided by the judicious use of immunohistochemistry (IHC). The aim of this study was to determine the usage rates of IHC stains in BFC, their type and indications, and their diagnostic impact. We also attempted to estimate the optimal rate of IHC use in BFC by comparing the entire laboratory's and each individual cytopathologist's IHC use rates with their respective indeterminate and malignant diagnosis rates. Methods We conducted a retrospective study of IHC stain use in BFC during a 5.5-year interval (2013-2018) and determined the laboratory's and each individual cytopathologist's IHC usage patterns according to the final diagnosis, site, and indications for their use. Results A total of 477 out of 4144 (11.5%) BFC cases had 2128 individual immunostains performed, with an average of 4.5 immunostains per case. Individual cytopathologists used IHC stains on 6.7% to 22% of their BFC cases. Pathologists with higher rates of IHC stain use than the laboratory's mean were less experienced and had higher rates of indeterminate but not of malignant diagnoses. The most common indication for the use of IHC stains was differentiating mesothelial from malignant cells. MOC31, calretinin, Ber-EP4, CD68, and D2-40 were the most commonly used of the 67 different IHC stains used in BFC. Conclusions The laboratory's mean may represent the optimal IHC use rate, as higher IHC use rates did not lead to more diagnostic certainty or higher pickup rates of malignant cells.
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المؤلفون: Krupa Patel-Lippmann, Timothy McMahon, Lisa Barroilhet, Elizabeth Maddox, Viktoriya Paroder, Alexander D. Blaty, Katherine E. Maturen, Emmanuel Sampene, Ashish P. Wasnik, Jessica B. Robbins, Elizabeth A. Sadowski
المصدر: American Journal of Roentgenology. 214:694-700
مصطلحات موضوعية: Adult, medicine.medical_specialty, Adolescent, Population, Malignancy, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, Diagnosis, Differential, Iota, 03 medical and health sciences, Ovarian tumor, 0302 clinical medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, education, Aged, Retrospective Studies, Ultrasonography, Aged, 80 and over, Ovarian Neoplasms, education.field_of_study, Cysts, business.industry, Ultrasound, General Medicine, Middle Aged, medicine.disease, Multicenter study, Adnexal Diseases, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Female, Radiology, Indeterminate, business, Adnexal cysts
الوصف: OBJECTIVE. The purpose of this study was to evaluate the International Ovarian Tumor Analysis (IOTA) simple rules and the Society of Radiologists in Ultrasound (SRU) guidelines for detecting ovarian malignancy in a general population of women presenting to radiology departments with adnexal cystic lesions. MATERIALS AND METHODS. A retrospective multicenter study of ultrasound-detected adnexal cystic lesions with appropriate follow-up was conducted. Lesions were classified into benign, indeterminate, or malignant categories according to criteria based on the IOTA simple rules and the SRU guidelines. The prevalence of nonneoplastic cysts, neoplasms, and malignant tumors was calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and ROC analysis for the diagnosis of malignancy was performed. RESULTS. A total of 697 women with 764 cystic lesions were included; 85.2% (651/764) of the lesions were nonneoplastic, 12.2% (93/764) were benign neoplasms, and 2.6% (20/764) were malignant neoplasms. Nearly all malignancies were classified into indeterminate and malignant categories. The prevalence of malignancy in the indeterminate category was 4.8% (7/145) (SRU) to 10.7% (7/65) (IOTA) and in the malignant category was 18.1% (13/72) (SRU) to 34.3% (12/35) (IOTA). Only one malignancy was misclassified as benign by the IOTA simple rules. The sensitivity of the IOTA simple rules for malignancy was 90.0%; specificity, 96.5%; PPV, 29.0%; NPV, 99.8%; and accuracy, 96.4%. The corresponding values for the SRU guidelines were 100%, 89.6%, 14.9%, 100%, and 89.8%. In ROC analysis, the IOTA simple rules were slightly more accurate than the SRU guidelines (AUC, 0.9805 versus 0.9713; p = 0.0003). CONCLUSION. Both imaging characterization methods were sensitive for identifying ovarian malignancies, but the PPV was low among women presenting to radiology departments, and the indeterminate classification harbored one-third of the total malignancies. Exploration of varied clinical settings and inclusion of secondary tests may help to refine these systems.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a255bfdb82c057bc5b1c43bc5f37ed01
https://doi.org/10.2214/ajr.18.20630 -
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المؤلفون: Nadia V. Halstead, Sarah Hecht, Jonathan P. Walker, Nicholas G. Cost
المصدر: Urology. 137:168-172
مصطلحات موضوعية: Male, medicine.medical_specialty, Neurofibromatosis 1, Biopsy, Urology, Priapism, 030232 urology & nephrology, Prostate Embryonal Rhabdomyosarcoma, urologic and male genital diseases, Malignancy, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Positron Emission Tomography Computed Tomography, medicine, Humans, Rhabdomyosarcoma, Embryonal, Stage (cooking), Neurofibromatosis, Child, Rhabdomyosarcoma, Penile Neoplasms, neoplasms, Neoplasm Staging, medicine.diagnostic_test, business.industry, Prostatic Neoplasms, Chemoradiotherapy, medicine.disease, Magnetic Resonance Imaging, female genital diseases and pregnancy complications, Treatment Outcome, Urinary Bladder Neoplasms, 030220 oncology & carcinogenesis, Embryonal rhabdomyosarcoma, Radiology, Neoplasm Recurrence, Local, business, Penis
الوصف: Neurofibromatosis-1 has a known increased risk of malignancy with rhabdomyosarcoma occurring in up to 6% of patients. Here we report on an 8-year-old male with a history of Neurofibromatosis-1 and previously treated stage 3, group III bladder/prostate embryonal rhabdomyosarcoma (diagnosed at 18 months old) who presented with penile swelling concerning for priapism. Imaging and subsequent biopsy confirmed embryonal rhabdomyosarcoma of the penile corporal bodies. Penile rhabdomyosarcoma is exceedingly rare, with less than 15 case reports in the literature. Our patient received chemoradiation per D9803 with organ preserving local control and is doing well 3 months after treatment.
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المؤلفون: Amrik S. Ray, Terrence E. Murphy, Isabel Cortopassi, Changyi Li, Katy L. B. Araujo, Erin M. DeBiasi, Guoping Cai, Jonathan Puchalski, Margaret A. Pisani, Kyle Bramley
المصدر: Ann Thorac Surg
مصطلحات موضوعية: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Forceps, Lymphadenopathy, 030204 cardiovascular system & hematology, Malignancy, Article, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Bronchoscopy, Mediastinal Diseases, medicine, Retrospective analysis, Humans, Endobronchial ultrasound, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Aged, Retrospective Studies, Suspicious for Malignancy, business.industry, Reproducibility of Results, Retrospective cohort study, Middle Aged, Surgical Instruments, medicine.disease, 030228 respiratory system, Specimen Quality, Female, Surgery, Lymph Nodes, Radiology, Sarcoidosis, Cardiology and Cardiovascular Medicine, business
الوصف: BACKGROUND. Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) has a high diagnostic yield when evaluating mediastinal and hilar lymphadenopathy (LAD). Having previously demonstrated the safety of EBUS-guided cautery-assisted transbronchial nodal forceps biopsy (ca-TBFB), we report disease-specific improvements in diagnostic yield and tissue acquisition when supplementing the EBUS-TBNA–based standard ofcare (SOC) with ca-TBFB. METHODS. We retrospectively reviewed 213 patients who sequentially underwent SOC and ca-TBFB during the same procedure. We determined 3 clinical scenarios of interest based on preprocedural imaging: isolated mediastinal/hilar LAD, LAD associated with a nodule or mass suspicious for malignancy, and LAD associated with parenchymal findings suggestive of sarcoidosis. Using validated methods, we assessed diagnostic yield on a per-patient basis and specimen quality on a per-node basis on the 136 patients meeting diagnostic criteria. RESULTS. Administration of disease-specific SOC with ca-TBFB yielded gains that varied by diagnosis. Diagnostic yields of SOC and its supplementation with ca-TBFB were 91.8% and 93.4% (P = .50) of the 61 patients diagnosed with solid-organ malignancy, 62.7% and 94.9% (P < .001) of the 59 patients diagnosed with sarcoidosis, and 62.5% and 93.8% (P = .042) of the 16 patients diagnosed with lymphoma, the. For each disease process, specimens obtained with ca-TBFB exhibited statistically higher quality. CONCLUSIONS. We suggest that relative to SOC, ca-TBFB improves diagnostic yield for sarcoidosis and lymphoma while providing uniformly better tissue quality and cellularity. We propose a protocol for use of this innovative technique.
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المؤلفون: Junko Ozao-Choy, Christine Dauphine, Kathryn T. Chen, Vikas Satyananda, Natalie C. McClintock, Danielle M. Hari
المصدر: Journal of Surgical Research. 247:103-107
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Radiography, Soft Tissue Neoplasms, Liposarcoma, Malignancy, Atypical Lipomatous Tumor, Diagnosis, Differential, Surgical pathology, 03 medical and health sciences, 0302 clinical medicine, Preoperative Care, Biopsy, medicine, Humans, Retrospective Studies, medicine.diagnostic_test, business.industry, Soft tissue, Middle Aged, Lipoma, medicine.disease, Magnetic Resonance Imaging, Tumor Burden, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Female, 030211 gastroenterology & hepatology, Surgery, Biopsy, Large-Core Needle, Radiology, business
الوصف: Background Lipomatous masses are the most common soft tissue tumors. While the majority are benign lipomas, it is important to identify those masses that are malignant prior to excision. Current guidelines recommend core needle biopsy (CNB) for all lipomatous masses larger than 3-5 cm. The objective of this study was to determine if routine preoperative CNB based on mass size is necessary, or if radiographic features can guide the need for CNB. Materials and methods Patients who underwent excision of extremity or truncal lipomatous masses at a single institution from October 2014 to July 2017 were retrospectively reviewed. By protocol, preoperative imaging was routinely obtained for all masses larger than 5 cm. High-risk radiographic features (intramuscular location, septations, nonfat nodules, heterogeneity, and ill-defined margins) and surgical pathology were evaluated to determine patients most likely to benefit from preoperative CNB. Results Of 178 patients, 2 (1.1%) had malignant tumors on surgical pathology. All masses smaller than 5 cm were benign and, if imaging was obtained, had two or fewer high-risk radiographic features. Both of the patients with malignant tumors had masses larger than 5 cm, preoperative imaging that showed at least four high-risk radiographic features, and underwent CNB prior to excision. Conclusions The overall rate of malignancy is very low. The results of this study suggest that lipomatous masses smaller than 5 cm without concerning clinical characteristics do not require preoperative imaging or CNB. Conversely, lipomatous masses larger than 5 cm should undergo routine MRI with subsequent CNB if multiple high-risk radiographic features are present.
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المؤلفون: Michele Droz dit Busset, Andre Gorgen, Gonzalo Sapisochin, Vincenzo Mazzaferro, Sasan Roayaie
المصدر: Journal of Hepatology. 72:364-377
مصطلحات موضوعية: 0301 basic medicine, Antimetabolites, Antineoplastic, medicine.medical_specialty, medicine.medical_treatment, Liver transplantation, Malignancy, Chronic liver disease, Cholangiocarcinoma, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Hepatectomy, Humans, Chemoembolization, Therapeutic, Intrahepatic Cholangiocarcinoma, Hepatology, business.industry, Patient Selection, medicine.disease, Neoadjuvant Therapy, Liver Transplantation, Transplantation, Treatment Outcome, 030104 developmental biology, Bile Duct Neoplasms, Chemotherapy, Adjuvant, Hepatocellular carcinoma, Lymph Node Excision, 030211 gastroenterology & hepatology, Lymphadenectomy, Radiology, business, Adjuvant
الوصف: The incidence of intrahepatic cholangiocarcinoma (iCCA) is increasing worldwide. Although several advances have been made in the past decades to better understand this complex malignancy and to develop new treatment strategies, the prognosis of iCCA remains dismal. Liver resection (LR) is the mainstay of treatment but only a minority of patients are amenable to surgery. In most cases, patients with iCCA will require a major hepatectomy for complete resection of the tumour. This may be contraindicated or increase the surgical burden in patients with chronic liver disease and small remnant liver volume. Lymphadenectomy with a minimal harvest of 6 lymph nodes is considered adequate, as microscopic nodal metastases have been shown in more than 40% of patients. Current 5-year overall survival following LR is in the range of 25%-40%. For locally advanced disease not amenable to upfront LR, neoadjuvant locoregional therapies may be used with the aim of converting these patients to resectability or even to transplantation in well-selected cases. Recent studies have shown that liver transplantation (LT) might be a treatment option for patients with unresectable very-early iCCA (i.e. ≤2 cm), with survival outcomes comparable to those of hepatocellular carcinoma. In patients with unresectable, advanced tumours, confined to the liver who achieve sustained response to neoadjuvant treatment, LT may be considered an option within prospective protocols. The role of adjuvant therapies in iCCA is still under debate. Herein, we review the recent advances in the surgical treatment of iCCA and examine its correlation with locoregional therapies, adjuvant and neo-adjuvant strategies.
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