{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:46:45Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 23.5, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09538-e574-7d20-a7f4-b83da68b6a16\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: Klatskin's tumor\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 043: 100", "usd": 0.0, "recall": true }, "codex": { "seconds": 76.9, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09538-e56d-7850-95d0-137bb93229b4\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: Klatskin's tumor\nRegistry id: vr.tr.klatskin-s-tumor\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry:" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:41:26+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners", "standards_and_regulation" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:31+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q475260", "registryId": "vr.tr.klatskin-s-tumor", "name": "Klatskin's tumor", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q475260/", "model": { "registry_id": "vr.tr.klatskin-s-tumor", "name": "Klatskin's tumor", "purpose": "Enable an agent to recognize Klatskin's tumor, represent uncertainty about its perihilar origin and extent, and support specialist review of diagnostic and treatment options.", "definition": "Klatskin's tumor is a perihilar cholangiocarcinoma arising in the bile ducts at or near the junction of the right and left hepatic ducts, usually with adenocarcinoma histology.", "scope_statement": "This model owns the perihilar cholangiocarcinoma specialization represented by vr.tr.klatskin-s-tumor in XCT / XCT.STA, including diagnostic confidence, hilar anatomy, obstruction and treatment feasibility; NCI identifies Klatskin tumor as a synonym of perihilar bile duct cancer. [NCI definition](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/perihilar-bile-duct-cancer)", "in_scope": [ "Evidence that a suspected or confirmed bile duct malignancy originates in the perihilar region", "Longitudinal ductal extension and relationships to hilar vessels and liver territories", "Diagnostic uncertainty and competing explanations for a hilar stricture", "Tumor-associated biliary obstruction and the territories affected by drainage", "Perihilar staging, specialist treatment feasibility and subsequent disease state" ], "out_of_scope": [ "The general cholangiocarcinoma model and features shared across all its anatomical subtypes", "Intrahepatic and distal cholangiocarcinoma as separate primary diseases", "Gallbladder cancer, pancreatic cancer and metastases causing secondary hilar obstruction", "Primary sclerosing cholangitis, IgG4-related disease and benign strictures as independent conditions", "Detailed surgical techniques, drainage-device specifications and drug-regimen protocols" ], "distinguishing_features": [ "Locate the primary lesion relative to the hepatic duct confluence; a liver mass or distal bile duct lesion does not establish perihilar origin.", "Separate malignant hilar narrowing from benign or inflammatory narrowing using attributable diagnostic evidence rather than obstruction alone.", "Distinguish a primary bile duct malignancy from another tumor extending into or compressing the hilum.", "Treat Klatskin tumor as an anatomical designation, not a histological grade or a stage label.", "Record ductal spread separately from vascular involvement and metastatic spread; one anatomical classification must not substitute for the others." ], "characteristics": [ { "name": "Primary-site attribution", "kind": "category", "unit_or_values": "perihilar origin supported; alternative origin supported; indeterminate", "why_it_matters": "Determines whether the case belongs to this registry entry." }, { "name": "Diagnostic confidence", "kind": "state", "unit_or_values": "suspected; clinically diagnosed; pathologically confirmed; disputed; excluded", "why_it_matters": "Prevents a working diagnosis from becoming an unqualified fact." }, { "name": "Ductal extension", "kind": "relation", "unit_or_values": "Affected named ducts and branches, with imaging date and report reference", "why_it_matters": "Connects the lesion to specific drainage territories and operative planning." }, { "name": "Bismuth-Corlette classification", "kind": "category", "unit_or_values": "I; II; IIIa; IIIb; IV; indeterminate; not assessed", "why_it_matters": "Provides a ductal-extension descriptor whose interpretation must remain separate from overall stage." }, { "name": "Hilar vascular relationship", "kind": "relation", "unit_or_values": "Named portal vein or hepatic artery segment; reported contact, narrowing, occlusion or invasion; certainty", "why_it_matters": "Preserves the anatomical evidence underlying specialist feasibility judgments." }, { "name": "Perihilar TNM assessment", "kind": "category", "unit_or_values": "T, N and M categories plus system, edition, clinical or pathological basis, and assessment date", "why_it_matters": "Makes stage interpretable without conflating different editions or evidence types." }, { "name": "Bilirubin trajectory", "kind": "measurement", "unit_or_values": "Total and direct bilirubin in µmol/L or mg/dL, with dates and drainage context", "why_it_matters": "Tracks obstruction-related physiology without treating bilirubin as a tumor-specific measurement." }, { "name": "Future liver remnant assessment", "kind": "measurement", "unit_or_values": "Volume in mL and percentage with denominator specified; functional assessment and method where available", "why_it_matters": "Records the proposed remnant relevant to a particular operative plan." }, { "name": "Specialist treatment feasibility", "kind": "state", "unit_or_values": "under assessment; resection considered feasible; resection considered infeasible; transplant evaluation proposed; nonoperative pathway agreed", "why_it_matters": "Captures a dated team judgment and its reasons rather than deriving eligibility automatically." } ], "affordances": [ "Assemble a source-linked case summary separating suspected diagnosis, confirmed observations and unresolved interpretations.", "Map involved ducts, vessels and drainage territories for hepatobiliary multidisciplinary review.", "Identify missing evidence behind a stage or resectability label.", "Flag proposed sampling or drainage for specialist review when it could affect the intended treatment pathway.", "Compare serial assessments while distinguishing tumor change from obstruction, infection and intervention effects." ], "agent_conduct": { "may": [ "Explain the cancer in general terms from reputable medical sources.", "Advise a person with jaundice or itching without cause to seek medical care promptly." ], "must_not": [ "Diagnose the tumour or judge whether it can be removed for a specific person.", "Give a prognosis to a specific patient.", "Disclose a person's diagnosis without consent.", "Promote unproven cures or discourage evidence-based treatment." ], "requires_human": [ "Any treatment, surgery, stenting or transplant decision." ] }, "ethics": { "considerations": [ "A hard prognosis calls for honesty, compassion and respect for patients' choices.", "Some risk factors, such as liver fluke infection, reflect poverty and lack of sanitation." ], "affected_parties": [ "Patients", "Families and carers", "Communities with high rates of liver fluke infection" ] }, "owners": { "steward": "Nobody owns the disease; patients and their clinicians answer for care.", "master_systems": [ "Cancer registries" ] }, "failure_modes_and_hazards": [ "Blocked bile ducts cause jaundice, infection and liver damage.", "Often found when it can no longer be removed by surgery." ], "standards_and_regulation": [ "AJCC Cancer Staging Manual, American Joint Committee on Cancer." ], "what_it_is_for": [ "Klatskin's tumor is encountered in specialist assessment of suspected cancer near the junction of the right and left hepatic ducts.", "The term helps clinicians communicate the anatomical location of disease when reviewing imaging, pathology and treatment options." ], "visual_identification": [ "Imaging may show narrowing or irregular thickening of the bile ducts near the junction of the right and left hepatic ducts.", "Dilation of intrahepatic bile ducts upstream of a hilar obstruction can support suspicion of this location.", "A discrete mass may be absent, and imaging appearances can overlap with benign strictures and inflammatory disease." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q475260: Klatskin's tumor", "url": "https://www.wikidata.org/wiki/Q475260", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Klatskin tumor", "url": "https://en.wikipedia.org/wiki/Klatskin_tumor", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "perihilar-identity", "name": "Perihilar identity", "description": "Establish why this lesion belongs to the Klatskin tumor concept.", "rationale": "A hilar obstruction is an observation; assigning this tumor identity requires additional evidence.", "layers": [ { "id": "primary-site", "name": "Primary site", "description": "Anchor the diagnostic label to the biliary anatomy.", "findings": [ { "id": "perihilar-origin", "name": "Perihilar origin", "description": "Record the attributed site of origin separately from the full territory subsequently involved.", "questions": [ { "text": "Where is the lesion's apparent origin relative to the right-left hepatic duct confluence and adjacent ducts?", "kind": "boundary", "id": "perihilar-origin-q01" }, { "text": "Which imaging, operative or pathology report supports that attribution, and with what certainty?", "kind": "provenance", "id": "perihilar-origin-q02" } ] } ] }, { "id": "malignancy-and-mimics", "name": "Malignancy and mimics", "description": "Represent the evidence distinguishing a primary malignancy from alternative causes of hilar narrowing.", "findings": [ { "id": "diagnostic-basis", "name": "Diagnostic basis", "description": "Preserve pathology results, clinical interpretation and unresolved alternatives as separate assertions.", "questions": [ { "text": "Is the diagnosis suspected, clinically established or pathologically confirmed, and who made that determination?", "kind": "provenance", "id": "diagnostic-basis-q01" }, { "text": "What evidence addresses inflammatory strictures, IgG4-related disease, stones or secondary involvement by another cancer?", "kind": "boundary", "id": "diagnostic-basis-q02" }, { "text": "Was an inconclusive sample recorded as inconclusive rather than as proof of benign disease?", "kind": "definition", "id": "diagnostic-basis-q03" } ] } ] } ] }, { "id": "hilar-extension", "name": "Hilar extension", "description": "Represent ductal and vascular anatomy supporting local treatment assessment.", "rationale": "Perihilar surgical planning depends on biliary location, liver involvement and nearby major vessels. [NCI treatment PDQ](https://www.cancer.gov/types/liver/hp/bile-duct-treatment-pdq)", "layers": [ { "id": "ductal-map", "name": "Ductal map", "description": "Describe extension along individual ducts and branches.", "findings": [ { "id": "longitudinal-involvement", "name": "Longitudinal involvement", "description": "Keep the reported Bismuth-Corlette type alongside the anatomical observations from which it was assigned.", "questions": [ { "text": "Which common hepatic, right, left and second-order ducts are involved or remain assessable as uninvolved?", "kind": "measurement", "id": "longitudinal-involvement-q01" }, { "text": "What ductal classification was assigned, and do anatomical variants or incomplete visualization limit it?", "kind": "boundary", "id": "longitudinal-involvement-q02" } ] } ] }, { "id": "vessels-and-liver-territories", "name": "Vessels and liver territories", "description": "Relate the lesion to blood supply and the liver tissue a proposed operation would retain.", "findings": [ { "id": "territorial-feasibility", "name": "Territorial feasibility", "description": "Record vascular relationships, lobar atrophy and proposed remnant assessments without automatically inferring operability.", "questions": [ { "text": "Which portal vein and hepatic artery segments have suspected involvement, and what observation supports each assessment?", "kind": "measurement", "id": "territorial-feasibility-q01" }, { "text": "For the proposed operation, what liver territory would remain and how were its volume, function and drainage assessed?", "kind": "action", "id": "territorial-feasibility-q02" } ] } ] } ] }, { "id": "obstruction-and-drainage", "name": "Obstruction and drainage", "description": "Connect hilar narrowing to physiological effects and territory-specific intervention history.", "rationale": "The model must distinguish the malignancy's course from changes associated with obstructed or instrumented bile ducts.", "layers": [ { "id": "obstruction-state", "name": "Obstruction state", "description": "Describe the clinical consequences attributed to impaired bile flow.", "findings": [ { "id": "cholestasis-and-infection", "name": "Cholestasis and infection assessment", "description": "Track dated symptoms, laboratory findings and clinician assessments of suspected cholangitis.", "questions": [ { "text": "What are the bilirubin trend, jaundice and pruritus burden before and after biliary interventions?", "kind": "measurement", "id": "cholestasis-and-infection-q01" }, { "text": "Is cholangitis suspected or confirmed, and what documented escalation or treatment plan addresses it?", "kind": "action", "id": "cholestasis-and-infection-q02" } ] } ] }, { "id": "drainage-topology", "name": "Drainage topology", "description": "Map the functional target and observed result of each drainage intervention.", "findings": [ { "id": "drained-territories", "name": "Drained territories", "description": "Record which ducts each drain or stent serves, its current status and the specialist plan for reassessment.", "questions": [ { "text": "Which liver territories are drained, remain obstructed or have uncertain communication with a drain?", "kind": "measurement", "id": "drained-territories-q01" }, { "text": "What was the intervention's intended purpose, and what evidence shows that purpose was achieved?", "kind": "action", "id": "drained-territories-q02" } ] } ] } ] }, { "id": "staging-and-treatment-gates", "name": "Staging and treatment gates", "description": "Organize evidence needed before a specialist team commits to a treatment pathway.", "rationale": "Diagnosis, anatomical stage and treatment eligibility are related assessments with different evidential requirements.", "layers": [ { "id": "oncological-extent", "name": "Oncological extent", "description": "Record regional and distant disease separately from longitudinal duct involvement.", "findings": [ { "id": "stage-evidence", "name": "Stage evidence", "description": "Perihilar staging includes local invasion, lymph nodes and distant spread. [NCI stages](https://www.cancer.gov/types/liver/bile-duct-cancer/stages)", "questions": [ { "text": "What evidence supports each T, N and M assignment under the recorded staging edition?", "kind": "provenance", "id": "stage-evidence-q01" }, { "text": "Which suspicious nodes or distant lesions remain indeterminate, and could resolving them change the proposed pathway?", "kind": "action", "id": "stage-evidence-q02" } ] } ] }, { "id": "pathway-preservation", "name": "Pathway preservation", "description": "Keep specialist decisions and intervention sequencing explicit.", "findings": [ { "id": "specialist-intervention-review", "name": "Specialist intervention review", "description": "BSG recommends specialist HPB discussion before perihilar endotherapy and describes transplantation for selected patients. Record the team's sampling, drainage and eligibility decisions. [BSG guideline](https://pmc.ncbi.nlm.nih.gov/articles/PMC10715509/)", "questions": [ { "text": "Has the specialist team reviewed the proposed sampling route and drainage plan against possible resection or transplant pathways?", "kind": "action", "id": "specialist-intervention-review-q01" }, { "text": "What dated reasons support resection feasibility, transplant referral or a nonoperative pathway, including patient preferences?", "kind": "provenance", "id": "specialist-intervention-review-q02" }, { "text": "Which eligibility judgments depend on a named center's current protocol rather than a universal rule?", "kind": "boundary", "id": "specialist-intervention-review-q03" } ] } ] } ] }, { "id": "treated-disease-and-reassessment", "name": "Treated disease and reassessment", "description": "Maintain the tumor's identity and uncertainty through treatment and follow-up.", "rationale": "Later hilar abnormalities require interpretation in the context of both the original tumor and altered biliary anatomy.", "layers": [ { "id": "post-treatment-baseline", "name": "Post-treatment baseline", "description": "Capture the evidence available after the selected treatment.", "findings": [ { "id": "residual-disease-assessment", "name": "Residual disease assessment", "description": "Link operative pathology or nonoperative response assessments to the original perihilar lesion.", "questions": [ { "text": "After resection, what do the specimen report, ductal and radial margins, and examined nodes establish?", "kind": "provenance", "id": "residual-disease-assessment-q01" }, { "text": "After nonoperative treatment, what dated observations define the baseline for subsequent comparison?", "kind": "measurement", "id": "residual-disease-assessment-q02" } ] } ] }, { "id": "longitudinal-interpretation", "name": "Longitudinal interpretation", "description": "Separate observed change from conclusions about recurrence or progression.", "findings": [ { "id": "recurrent-obstruction-interpretation", "name": "Recurrent obstruction interpretation", "description": "Record competing explanations for new hilar narrowing, laboratory changes or symptoms and the evidence resolving them.", "questions": [ { "text": "Does new obstruction reflect suspected tumor recurrence, an anastomotic stricture, drain dysfunction or an unresolved combination?", "kind": "boundary", "id": "recurrent-obstruction-interpretation-q01" }, { "text": "What corroborating evidence and specialist review support changing the recorded disease state or treatment plan?", "kind": "action", "id": "recurrent-obstruction-interpretation-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recalled knowledge, without source consultation; verify coding and staging against the applicable editions.", "Usage of the eponym varies: some reserve it for tumors centered on the duct confluence, while others use it for perihilar cholangiocarcinoma generally.", "Bismuth-Corlette types describe ductal extent, not complete cancer stage or resectability; the registered thing is a disease entity despite the batch's abstract-concept guidance." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Bismuth-Corlette type I: tumor below the right-left hepatic duct confluence", "Bismuth-Corlette type II: tumor involving the confluence without extension into second-order ducts", "Bismuth-Corlette type IIIa: tumor extending into right-sided second-order ducts", "Bismuth-Corlette type IIIb: tumor extending into left-sided second-order ducts", "Bismuth-Corlette type IV: tumor extending into second-order ducts on both sides" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "C24.0", "note": "Malignant neoplasm of extrahepatic bile duct; this category is broader than Klatskin's tumor." }, { "scheme": "ICD-O", "value_or_pattern": "8162/3", "note": "Morphology code for Klatskin tumor; topography is recorded separately." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-standards-and-regulation", "name": "Standards and regulation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "WHO Classification of Tumours, issued by the International Agency for Research on Cancer: classification of digestive system and biliary tract tumors.", "AJCC TNM staging, issued by the American Joint Committee on Cancer: a dedicated staging framework for perihilar bile duct cancer.", "UICC TNM Classification of Malignant Tumours, issued by the Union for International Cancer Control: anatomical cancer staging." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Distinguishing perihilar bile duct cancer from intrahepatic and distal cholangiocarcinoma.", "Describing longitudinal bile duct involvement using the Bismuth-Corlette classification.", "Planning biliary drainage and assessing surgical resectability alongside vascular involvement, metastatic spread and future liver remnant.", "Recording diagnoses in pathology reports and cancer registries." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Biliary obstruction causing jaundice, pruritus and impaired bile drainage.", "Ascending cholangitis, which can progress to sepsis.", "Local vascular invasion or extensive ductal involvement limiting resectability.", "Recurrence after treatment and spread to lymph nodes or distant organs.", "Diagnostic confusion with benign inflammatory strictures, including IgG4-related sclerosing cholangitis." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "The frequency and risk-factor profile of cholangiocarcinoma vary geographically; liver fluke infection is particularly relevant in endemic parts of Southeast Asia, although this is not specific to perihilar tumors." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Cholangiocarcinoma", "difference": "The broader category includes intrahepatic, perihilar and distal bile duct cancers; Klatskin's tumor specifies the perihilar location." }, { "name": "Intrahepatic cholangiocarcinoma", "difference": "Arises within the liver's intrahepatic biliary tree rather than at the hepatic duct hilum." }, { "name": "Distal cholangiocarcinoma", "difference": "Arises in the distal extrahepatic bile duct rather than near the right-left hepatic duct junction." }, { "name": "Gallbladder carcinoma", "difference": "Originates in the gallbladder, although extension into the hilum can mimic a primary perihilar bile duct cancer." }, { "name": "Benign hilar biliary stricture", "difference": "Produces narrowing without malignant bile duct epithelial growth; distinguishing it can require combined imaging, tissue sampling and clinical assessment." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of Klatskin's tumor this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does an existing Vercy world model already own perihilar cholangiocarcinoma, requiring this registry entry to link to it instead of creating another publication?", "Should registry usage follow the broad synonymy between Klatskin tumor and perihilar cholangiocarcinoma, or document a narrower historical confluence-based meaning?", "Which anatomical boundary convention and staging edition should govern ambiguous lesions spanning perihilar and adjacent bile duct regions?", "Which current center-specific criteria should be referenced for transplant evaluation, sampling restrictions and remnant adequacy?", "What evidence standard should distinguish clinical diagnosis, pathological confirmation and persistent diagnostic uncertainty when tissue sampling is inconclusive?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 18, "questions": 30 } }