Gigante E, Ronot M, Bertin C, et al. - In this retrospective study, researchers assessed the diagnostic performance of imaging utilizing computed tomography and/or magnetic resonance and biopsy for the diagnosis of combined hepatocellular-cholangiocarcinoma (cHCC-CCA). Between December 2006 and April 2017, cHCC-CCA resected with available preoperative imaging and tumor biopsy were involved. The diagnosis of cHCC-CCA was based on morphological and immunophenotypical characteristics. A total of 21 cHCC-CCA have been compared to 21 intra-hepatic cholangiocarcinoma as controls. Data reported that the presence of a type III pattern at imaging had a sensitivity (48%) and specificity (81%) for cHCC-CCA diagnosis. In 8/21 patients, the initial diagnosis performed on biopsy was cHCC-CCA. The sensitivity and specificity were 60% and 82%, respectively, when either imaging or biopsy suggested the cHCC-CCA diagnosis. The authors demonstrated that the diagnostic performance of cHCC-CCA was enhanced by a two-step strategy combining imaging as the first step and biopsy as the second.