Challenges of Cholangiocarcinoma Detection in Patients with Primary Sclerosing Cholangitis
Keywords:Neoplasm, bile duct neoplasms, bile duct diseases, biological tumor marker, magnetic resonance imaging, ultrasonography, cytological techniques, fluorescence in situ hybridization, early detection of cancer, mass screening, imaging, cholangiography
Primary sclerosing cholangitis (PSC) is a chronic, cholestatic, idiopathic liver disease characterized by fibro-obliterative inflammation of the hepatic bile ducts. In a clinically significant proportion of patients, PSC progresses to cirrhosis, end-stage liver disease, and in some cases, cholangiocarcinoma (CCA). The development of CCA in PSC is unpredictable, its surveillance and diagnosis complex, and its treatment options limited unless detected early. Herein we provide a focused review of the current literature regarding CCA surveillance in patients with PSC and discuss the diagnostic and management challenges that exist. Where evidence is limited, we present our perspective and approach as well as directions for future research.
Aron JH, Bowlus CL. The immunobiology of primary sclerosing cholangitis. Semin Immunopathol [Review] 2009; 31(3): 383-97. http://dx.doi.org/10.1007/s00281-009-0154-7
Razumilava N, Gores GJ, Lindor KD. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology [Review] 2011; 54(5): 1842-52. http://dx.doi.org/10.1002/hep.24570
Kaplan GG, Laupland KB, Butzner D, Urbanski SJ, Lee SS. The burden of large and small duct primary sclerosing cholangitis in adults and children: a population-based analysis. Am J Gastroenterol 2007; 102(5): 1042-9. http://dx.doi.org/10.1111/j.1572-0241.2007.01103.x
Pollheimer MJ, Halilbasic E, Fickert P, Trauner M. Pathogenesis of primary sclerosing cholangitis. Best Pract Res Clin Gastroenterol [Research Support, Non-U.S. Gov't] 2011; 25(6): 727-39.
Tabibian JH, O'Hara SP, Larusso NF. Primary Sclerosing Cholangitis: The Gut-Liver Axis. Clin Gastroenterol Hepatol [Letter] 2012. http://dx.doi.org/10.1016/j.cgh.2012.01.024
Fevery J, Verslype C, Lai G, Aerts R, Van Steenbergen W. Incidence, diagnosis, and therapy of cholangiocarcinoma in patients with primary sclerosing cholangitis. Dig Dis Sci [Case Reports] 2007; 52(11): 3123-35. http://dx.doi.org/10.1007/s10620-006-9681-4
Charatcharoenwitthaya P, Enders FB, Halling KC, Lindor KD. Utility of serum tumor markers, imaging, and biliary cytology for detecting cholangiocarcinoma in primary sclerosing cholangitis. Hepatology [Research Support, Non-U.S. Gov't] 2008; 48(4): 1106-17.
Cote GA, Sherman S. Biliary stricture and negative cytology: what next? Clin Gastroenterol Hepatol [Case Reports] 2011; 9(9): 739-43. http://dx.doi.org/10.1016/j.cgh.2011.04.011
Bangarulingam SY, Bjornsson E, Enders F, et al. Long-term outcomes of positive fluorescence in situ hybridization tests in primary sclerosing cholangitis. Hepatology 2010; 51(1): 174-80. http://dx.doi.org/10.1002/hep.23277
Dave M, Elmunzer BJ, Dwamena BA, Higgins PD. Primary sclerosing cholangitis: meta-analysis of diagnostic performance of MR cholangiopancreatography. Radiology [Meta-Analysis] 2010; 256(2): 387-96.
Winick AB, Waybill PN, Venbrux AC. Complications of percutaneous transhepatic biliary interventions. Tech Vasc Interv Radiol [Review] 2001; 4(3): 200-6. http://dx.doi.org/10.1016/S1089-2516(01)90026-5
Park JS, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation. Gastrointest Endosc [Comparative Study] 2003; 57(1): 78-85. http://dx.doi.org/10.1067/mge.2003.11
Levy MJ, Baron TH, Clayton AC, et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol [Comparative Study Research Support, N.I.H., Extramural] 2008; 103(5): 1263-73.
Chapman R, Fevery J, Kalloo A, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology [Practice Guideline] 2010; 51(2): 660-78. http://dx.doi.org/10.1002/hep.23294
Siqueira E, Schoen RE, Silverman W, et al. Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis. Gastrointest Endosc [Research Support, Non-U.S. Gov't] 2002; 56(1): 40-7.
de Bellis M, Fogel EL, Sherman S, et al. Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc [Research Support, Non-U.S. Gov't] 2003; 58(2): 176-82.
Tischendorf JJ, Kruger M, Trautwein C, et al. Cholangioscopic characterization of dominant bile duct stenoses in patients with primary sclerosing cholangitis. Endoscopy 2006; 38(7): 665-9. http://dx.doi.org/10.1055/s-2006-925257
Ramchandani M, Reddy DN, Gupta R, et al. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc [Clinical Trial] 2011; 74(3): 511-9. http://dx.doi.org/10.1016/j.gie.2011.04.034
Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc [Research Support, Non-U.S. Gov't] 2007; 65(6): 832-41.
Barr Fritcher EG, Kipp BR, Voss JS, et al. Primary sclerosing cholangitis patients with serial polysomy fluorescence in situ hybridization results are at increased risk of cholangiocarcinoma. Am J Gastroenterol 2011; 106(11): 2023-8. http://dx.doi.org/10.1038/ajg.2011.272
Blechacz B, Gores GJ. Positron emission tomography scan for a hepatic mass. Hepatology [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't] 2010; 52(6): 2186-91.
Koprowski H, Steplewski Z, Mitchell K, Herlyn M, Herlyn D, Fuhrer P. Colorectal carcinoma antigens detected by hybridoma antibodies. Somatic Cell Genet [Research Support, U.S. Gov't, P.H.S.] 1979; 5(6): 957-71.
Magnani JL, Nilsson B, Brockhaus M, et al. A monoclonal antibody-defined antigen associated with gastrointestinal cancer is a ganglioside containing sialylated lacto-N-fucopentaose II. J Biol Chem [Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.] 1982; 257(23): 14365-9.
Brecher M. ABO, H, and Lewis Blood Groups and Structurally Related Antigens. Technical Manual Of The American Association of Blood Banks. 15 ed. Bethesda: American Association of Blood Banks 2005; pp. 305-6.
Levy C, Lymp J, Angulo P, Gores GJ, Larusso N, Lindor KD. The value of serum CA 19-9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis. Dig Dis Sci [Clinical Trial] 2005; 50(9): 1734-40. http://dx.doi.org/10.1007/s10620-005-2927-8
Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma. Transpl Int [Review] 2010; 23(7): 692-7. http://dx.doi.org/10.1111/j.1432-2277.2010.01108.x