Surveillance for cholangiocarcinoma in patients with primary sclerosing cholangitis: Effective and justified?

Abstract

http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/8-2-reading-razumilava.html a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/8-2-interview-razumilava.html the interview with the author

Surveillance for hepatobiliary cancers in patients with primary sclerosing cholangitis

“…US, however, was associated with comparable overall survival and was superior to CT. It is important to emphasize that the first‐line imaging modality for HBCa surveillance/diagnosis was determined based on clinician preference, and thus, high‐risk patients with PSC were not routinely surveilled with a set of imaging modality. Some hepatologists in our institution perform annual US combined with CA19‐9 for HBCa surveillance .…”

“…If US is reported as abnormal/suspicious (with or without CA19‐9 elevation), a recommendation is typically made for MRI/MRCP (preferably with contrast, as this enhances the imaging study and decreases the risk of underdiagnosis, particularly for subtle periductal tumors), ERC, or both . Other clinicians use MRI/MRCP combined with CA19‐9 as the first line for HBCa surveillance in patients with PSC . Additional studies to define the role of specific imaging methods for HBCa surveillance are needed and underway.…”

Serum extracellular vesicles contain protein biomarkers for primary sclerosing cholangitis and cholangiocarcinoma

“…Their incidence is increasing worldwide, CCAs represent the second most frequent primary liver tumor and ∼3% of all gastrointestinal cancers . The etiology remains largely unknown, but several conditions such as primary sclerosing cholangitis (PSC) increase the odds (∼5%‐15%) of developing CCA . Late diagnosis due to the lack of early symptoms as well as the refractory nature of these tumors seriously compromise the therapeutic options and patient outcome .…”

“…Late diagnosis due to the lack of early symptoms as well as the refractory nature of these tumors seriously compromise the therapeutic options and patient outcome . CCAs are commonly diagnosed in advanced stages, when the disease is disseminated, by combining imaging methods (i.e., computed tomography, magnetic resonance imaging [MRI], or endoscopic retrograde cholangiopancreatography), nonspecific tumor biomarkers in serum (i.e., carbohydrate antigen 19‐9 [CA19‐9] and carcinoembryonic antigen), and histological analysis of tumor biopsies . On the other hand, PSC is commonly diagnosed by magnetic resonance cholangiography and by histological analysis of biopsies .…”

“…On the other hand, PSC is commonly diagnosed by magnetic resonance cholangiography and by histological analysis of biopsies . To date, there is a lack of accurate noninvasive methods for the diagnosis of both PSC and CCA, as well as for the differential diagnosis between PSC versus CCA and intrahepatic CCA versus hepatocellular carcinoma (HCC) …”