Challenges in Diagnosing Cholangiocarcinoma: Pulling Together Biochemical, Radiological, and Cytopathological Data

Franssen, Stijn; Jong, David M. de; Driel, Lydi M.J.W. van; Koerkamp, B. Groot

doi:10.1007/978-3-030-70936-5_9

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…The Bismuth–Corlette classification subdivides pCCA according to which biliary ducts are involved [ 18 ]. The associated difficulty in obtaining adequate tissue in pCCA is a barrier to diagnosis, but crucially, also prevents molecular profiling analysis, resulting in the under-representation of pCCA in clinical trials of systemic therapy (see Table 1 ) and an impaired ability to identify and act on molecular targets in the clinic, respectively [ 19 ]. Regarding the limitations of subdividing CCA anatomically, both hilar and small bile ducts and ductules are present in the liver parenchyma at the perihilar and intrahepatic levels.…”

Section: Introductionmentioning

confidence: 99%

Targeted Therapies for Perihilar Cholangiocarcinoma

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et al. 2022

Cancers

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Perihilar cholangiocarcinoma (pCCA) is the anatomical sub-group of biliary tract cancer (BTC) arising between the second-order intrahepatic bile ducts and the cystic duct. Together with distal and intrahepatic cholangiocarcinoma (dCCA and iCCA; originating distal to, and proximal to this, respectively), gallbladder cancer (GBC) and ampulla of Vater carcinoma (AVC), these clinicopathologically and molecularly distinct entities comprise biliary tract cancer (BTC). Most pCCAs are unresectable at diagnosis, and for those with resectable disease, surgery is extensive, and recurrence is common. Therefore, the majority of patients with pCCA will require systemic treatment for advanced disease. The prognosis with cytotoxic chemotherapy remains poor, driving interest in therapies targeted to the molecular nature of a given patient’s cancer. In recent years, the search for efficacious targeted therapies has been fuelled both by whole-genome and epigenomic studies, looking to uncover the molecular landscape of CCA, and by specifically testing for aberrations where established therapies exist in other indications. This review aims to provide a focus on the current molecular characterisation of pCCA, targeted therapies applicable to pCCA, and future directions in applying personalised medicine to this difficult-to-treat malignancy.

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Section: Introductionmentioning

confidence: 99%

Targeted Therapies for Perihilar Cholangiocarcinoma

Gray

Lamarca

Edeline

et al. 2022

Cancers

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Hybrid FDG-PET/MRI for Diagnosis and Clinical Management of Patients with Suspected Perihilar Cholangiocarcinoma: A Feasibility Pilot Study

de Jong,

Chehin,

Meijering

et al. 2024

Nucl Med Mol Imaging

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Purpose Recently introduced hybrid 2-[18 F]-fluoro-2-deoxy-D-glucose (18 F-FDG) Positron Emission Tomography (PET) combined with Magnetic Resonance Imaging (MRI) may aid in proper diagnosis and staging of perihilar cholangiocarcinoma (pCCA). The aim of this study is to assess the effect of 18 F-FDG PET/MRI on diagnosis and clinical decision making in the pre-operative work up of pCCA. Methods In this single-centre pilot study patients with presumed resectable pCCA underwent state-of-the-art 18 F-FDG hybrid PET/MRI using digital silicone photomultiplier detectors integrated within a 3-Tesla bore. Data were collected on several baseline and imaging characteristics. The primary outcome measure was the added diagnostic information and the effect on clinical decision making. Secondary aim was to correlate quantitative PET signal intensity to patient- and tumour characteristics. High and low SUVmax subgroups related to the mean value were made. Significance of lesion- and patient characteristics with the high and low SUVmax subgroups, as well as TLR and TBR, was evaluated with Fisher’s exact test or Mann-Whitney-U test. Results In total 14 patients were included (mean age 62.4 years, 64% male). Final diagnosis was pCCA in 10 patients (71.4%), follicular lymphoma in one patient (7.1%) and benign disease in the remaining three patients. FDG-PET/MRI added valuable diagnostic information in six (43%) patients and affected clinical decision making in two of these patients (14%) by increasing confidence for malignancy which lead to the decision for surgery on short term. High SUVmax values were seen in half of cases with pCCA and half of cases with non-cancerous lesions. In addition, high SUVmax values were directly associated with primary sclerosing cholangitis when present (p = 0.03). Conclusion Simultaneous 18 F-FDG-PET/MRI added diagnostic information in six of fourteen patients and influenced clinical decision making in two patients (14%) with presumed resectable pCCA.

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Challenges in Diagnosing Cholangiocarcinoma: Pulling Together Biochemical, Radiological, and Cytopathological Data

Cited by 2 publications

References 27 publications

Targeted Therapies for Perihilar Cholangiocarcinoma

Targeted Therapies for Perihilar Cholangiocarcinoma

Hybrid FDG-PET/MRI for Diagnosis and Clinical Management of Patients with Suspected Perihilar Cholangiocarcinoma: A Feasibility Pilot Study

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