[ES]Introducci?n: El colangiocarcinoma perihiliar, o tumor de Klatskin, representa la forma m?s frecuente y agresiva del colangiocarcinoma extrahep?tico. Su localizaci?n en la intersecci?n de los conductos biliares y su sintomatolog?a inicial inespec?fica complican el diagn?stico en etapas iniciales, disminuyendo la probabilidad de una resecci?n quir?rgica curativa y estableciendo un pron?stico desfavorable. Frente a este reto, resulta imprescindible examinar las herramientas diagn?sticas m?s eficaces disponibles en la actualidad. Objetivos: Examinar los m?todos diagn?sticos utilizados en el tumor de Klatskin, evaluando su eficacia y utilidad cl?nica a trav?s de una revisi?n sistem?tica de la literatura cient?fica. Material y m?todos: Se realiz? una revisi?n sistem?tica siguiendo la gu?a PRISMA, a trav?s de la b?squeda en las bases de datos PubMed y Scopus. Se seleccionaron estudios publicados desde 2015 que valoraban t?cnicas de imagen, procedimientos endosc?picos o t?cnicas moleculares utilizados para el diagn?stico del colangiocarcinoma perihiliar. Se establecieron criterios de inclusi?n y exclusi?n predefinidos y se evalu? el riesgo de sesgo con la herramienta QUADAS-2. Resultados: De un total inicial de 900 art?culos, finalmente se incluyeron 15 estudios que cumpl?an los criterios establecidos. Se dividieron en tres grupos principales: t?cnicas de imagen (n=8), t?cnicas endosc?picas (n=2), y biopsia l?quida y biomarcadores moleculares (n=5). La RM en combinaci?n con RMCP con secuencias de alta resoluci?n o contraste hepatoespec?fico result? ser el m?todo m?s preciso para determinar la extensi?n y la capacidad de resecci?n. La colangioscopia peroral y la reconstrucci?n tridimensional del ?rbol biliar incrementaron la precisi?n diagn?stica y planificaci?n terap?utica. Finalmente, la detecci?n de VOCs, metilaci?n de ADN y mutaciones en bilis mediante t?cnicas moleculares demostr? altos valores de sensibilidad y especificidad estableci?ndose como instrumentos emergentes de gran potencial diagn?stico. Conclusiones: El abordaje diagn?stico del tumor de Klatskin requiere un car?cter multimodal combinando t?cnicas de imagen, endoscopia y biomarcadores moleculares. La validaci?n multic?ntrica y la estandarizaci?n de los protocolos son esenciales para su incorporaci?n a la pr?ctica cl?nica. El diagn?stico precoz aumenta las oportunidades de realizar un tratamiento curativo mediante cirug?a, mejorando notablemente el pron?stico y calidad de vida.

[EN]Introduction: Perihilar cholangiocarcinoma, also known as Klatskin tumor, is the most frequent and aggressive form of extrahepatic cholangiocarcinoma. Its location at the confluence of the bile ducts and its nonspecific initial symptoms complicate early diagnosis, reducing the likelihood of curative surgical resection and resulting in a poor prognosis. Given this challenge, it is essential to examine the most effective current diagnostic tools. Objectives: To examine the diagnostic methods used in Klatskin tumors, assessing their effectiveness and clinical utility through a systematic review of the scientific literature. Methods: A systematic review was conducted following the PRISMA guidelines through searches in the PubMed and Scopus databases. Studies published since 2015 evaluating imaging techniques, endoscopic procedures, or molecular approaches used for the diagnosis of perihilar cholangiocarcinoma were included. Predefined inclusion and exclusion criteria were applied, and risk of bias was assessed using the QUADAS-2 tool. Results: Out of an initial total of 900 articles, 15 studies met the established criteria and were included. They were grouped into three main categories: imaging techniques (n=8), endoscopic techniques (n=2), and molecular biomarkers and liquid biopsy (n=5). MRI combined with MRCP using high-resolution sequences or hepatobiliary-specific contrast agents proved to be the most accurate method for determining tumor extent and resectability. Peroral cholangioscopy and 3D biliary tree reconstruction improved diagnostic precision and therapeutic planning. Finally, detection of VOCs, DNA methylation, and mutations in bile using molecular techniques showed high sensitivity and specificity, emerging as promising diagnostic tools. Conclusions: The diagnostic approach to Klatskin tumors must be multimodal, integrating imaging, endoscopy, and molecular biomarkers. Multicenter validation and standardized protocols are essential for clinical implementation. Early diagnosis increases the chances of curative surgical treatment, significantly improving prognosis and quality of life.

Trabajo de fin de grado. Grado en Medicina. Curso acad?mico 2024-2025