ACR Appropriateness Criteria® Staging and Follow-Up of Biliary Cancer.
Oct 28, 2026DOI: 10.1016/j.jacr.2026.09.017Journal ArticleJACR
Written by: Expert Panel on Gastrointestinal ImagingOmar KamalAlice FungAbhinav VijBrooks D CashRiham H El KhouliMartha MenchacaTamer RefaatNilan D SchnureRachna T ShroffElainea N SmithKiran H ThakrarShaun A WahabSherry S WangElena K Korngold
Biliary tract cancers, comprising gallbladder cancer and intrahepatic and extrahepatic cholangiocarcinoma, are uncommon but aggressive malignancies that are often diagnosed at an advanced stage. Accurate staging is critical because patients with localized disease may be candidates for curative resection, whereas those with unresectable or metastatic disease are triaged to systemic and palliative therapy. This document reviews the evidence for imaging in five clinical scenarios: locoregional staging of gallbladder cancer, locoregional staging of cholangiocarcinoma, staging of distant metastatic disease, posttreatment evaluation, and surveillance. Contrast-enhanced CT and MRI of the abdomen are the mainstays of locoregional assessment, whereas CT of the chest, abdomen, and pelvis and FDG-PET are used for distant staging and follow-up. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
