The sensitivity of biliary brush border cytology is very low. A spyglass-bite biopsy under direct vision would be very useful. However, in the era of high resolution imaging, a proper triple phase MRI/CT should be able to diagnose Hilar CC. ERCP and Biopsy are not indicated as they may inflict an inflammatory reaction producing difficulty during surgery. Since Hilar CC can be treated with upfront surgery and does not require Neo-adjuvant CT, one may proceed with surgery after a radiological diagnosis supported by tumor markers.