Sonographic Predictors for Developing Cholangiocarcinoma: A Cohort Study from an Endemic Area.

Background and aim: Cholangiocarcinoma (CCA) is an aggressive malignancy with a poor prognosis. Bile duct and peribiliary changes related to CCA may present on ultrasound (US) findings. This study aims to evaluate US findings that could be used as predictors for developing CCA through our surveillance program in an endemic area of Thailand.

Methods: The study population was 4,337 villagers in Northern Thailand with a 5-year abdominal US surveillance. Patient demographics data and ultrasound findings of calcifications/granulomas, periductal fibrosis, and diffuse bile duct dilatation were included. A logistic regression model was used to determine significant predictors.

Results: There were 4,225 people included with an average age of 45.49±7.66 years. Prevalence of calcifications/granulomas, periductal fibrosis, and diffuse bile duct dilatation detected on baseline sonographic surveillance was 11.7%, 20.5%, and 11.3%, respectively. The univariate analysis for significant predictors for CCA include age (Relative Risk; RR = 1.12), family history of CCA (RR = 2.29), periductal fibrosis (RR=2.38), and diffuse bile duct dilatation  (RR = 7.59). The multivariate analysis the independent predictors were age (RR = 1.12), family history of CCA (RR = 1.92), and diffuse bile duct dilatation (RR = 5.94), respectively.

Conclusions: The sonographic predictor for CCA surveillance in endemic areas is diffuse bile duct dilatation.  Age and family history of CCA are also helpful clinical markers.