Hepatocellular carcinoma with obstructive jaundice: Biliary drainage and multimodal therapy

Table 1 Selected classification systems for bile duct tumor thrombus in hepatocellular carcinoma

Classification	Type	Definition	Interpretive use
Satoh	1	BDTT in a first-order hepatic duct branch without reaching the right-left duct confluence	Anatomically limited intraductal extension
Satoh	2	BDTT extending across the right-left hepatic duct confluence	Hilar involvement
Satoh	3	BDTT separated from the primary HCC and growing in the common bile duct	Detached/distal intraductal disease
Zhou et al[11]	I	Microscopic BDTT	Detected pathologically
Zhou et al[11]	II	Resectable primary or recurrent HCC with BDTT	Resectability-oriented category
Zhou et al[11]	III	BDTT without an obvious intrahepatic HCC mass	High diagnostic-mimic risk
Zhou et al[11]	IV	BDTT with unresectable intrahepatic or extrahepatic HCC	Systemic/non-surgical disease context
Zhou et al[11]	a/b	Subclassified by presence/absence of extrahepatic bile duct wall invasion	Proposed surgical-pathology modifier

Zhou et al’s proposal[11] has not been prospectively validated. BDTT: Bile duct tumor thrombus; HCC: Hepatocellular carcinoma.