The ACR Appropriateness Criteria for staging and follow-up of biliary tract cancer cover five scenarios: local staging of gallbladder cancer, local staging of cholangiocarcinoma, distant staging, assessment after treatment, and surveillance.
Contrast-enhanced CT and MRI of the abdomen are the main tools for local assessment, the step that decides whether a tumour may be resectable. CT of the chest, abdomen and pelvis and FDG-PET are used for distant staging and follow-up.
The ratings come from a multidisciplinary panel using the RAND/UCLA appropriateness method; where evidence is thin, expert opinion fills the gap, and these are uncommon cancers with limited trial data.
For departments, the practical point is consistency: a staging request for suspected gallbladder cancer or cholangiocarcinoma should trigger a protocol designed to answer the resectability question, with distant staging alongside, rather than a routine single-phase abdominal CT.
- Use contrast-enhanced CT or MRI of the abdomen for local staging of biliary cancer.
- Add CT of the chest, abdomen and pelvis for distant staging.
- Consider FDG-PET for distant staging and follow-up where it would change management.
- Report vascular involvement and ductal extent explicitly to answer the resectability question.
- Agree a dedicated biliary staging protocol with the hepatobiliary team.
Why it matters
Most of these cancers present late, so the staging scan often decides between surgery and palliation.
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