title: Ultrasound screening for cholangiocarcinoma could detect premalignant lesions and early-stage diseases with survival benefits: a population-based prospective study of 4,225 subjects in an endemic area.
abstract: Thailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north and northeastern regions. Most CCA patients come at a late, unresectable stage and presently no optimal screening test for CCA has been established. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits.
  
  
  
  A 5-year population-based study was started in October, 2011 for consented Thai individuals, aged 30-60 years. The screening program comprised blood testing, stool examination and serial ultrasonography every 6 months.
  
  
  
  During the first 3 years, 4,225 eligible individuals were enrolled. CCA was detected in 32 patients, with a mean age of 51.9 years (41-62 years), and 21/32 cases were at a curative resectable stage. The prevalence rate of CCA was 165.7 per 100,000 and one- and two-year incidence rate was 236.7/100,000 and 520.7/100,000, respectively. One- and 2-year overall survival rates of CCA patients were 90.9 and 61.5 %, respectively. Prognosis was better in resectable cases with 100 % 1-year and 77.8 % 2-year survival rates. Interestingly, premalignant pathological lesions (stage 0) were identified in 11 cases with 100 % 3-year survival rate. Serum biomarkers and alkaline phosphatase were not sufficient to detect early-stage disease. In 22 patients, stool samples were positive for Opistorchis viverrini, based on polymerase chain reaction.
  
  
  
  Detection of premalignant lesions and early-stage resectable CCA by ultrasonography resulted in improved clinical outcome. Ultrasonography should be offered as a first screening tool for CCA in an endemic area until other useful biological markers become available.
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Prakongboon
authors.initials: P
authors.lastname: Sungkasubun
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Surachate
authors.initials: S
authors.lastname: Siripongsakun
authors.affiliation: Ban Luang Hospital, 191 Pa Kha Luang, Ban Luang, Nan, 55190, Thailand.
authors.forename: Kunlayanee
authors.initials: K
authors.lastname: Akkarachinorate
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Sirachat
authors.initials: S
authors.lastname: Vidhyarkorn
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Akeanong
authors.initials: A
authors.lastname: Worakitsitisatorn
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Thaniya
authors.initials: T
authors.lastname: Sricharunrat
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Sutida
authors.initials: S
authors.lastname: Singharuksa
authors.affiliation: National Cancer Institute of Thailand, 268/1 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Rawisak
authors.initials: R
authors.lastname: Chanwat
authors.affiliation: National Cancer Institute of Thailand, 268/1 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
authors.forename: Chairat
authors.initials: C
authors.lastname: Bunchaliew
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Sirima
authors.initials: S
authors.lastname: Charoenphattharaphesat
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Ruechuta
authors.initials: R
authors.lastname: Molek
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Maneenop
authors.initials: M
authors.lastname: Yimyaem
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Gaidganok
authors.initials: G
authors.lastname: Sornsamdang
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Kamonwan
authors.initials: K
authors.lastname: Soonklang
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.
authors.forename: Kasiruck
authors.initials: K
authors.lastname: Wittayasak
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand.|Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
authors.forename: Chirayu U
authors.initials: CU
authors.lastname: Auewarakul
authors.affiliation: Chulabhorn Hospital, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210,, Thailand. cmah2500@gmail.com.|Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. cmah2500@gmail.com.|Chulabhorn Research Institute, 54 Kamphaeng Phet 6 Road, Laksi, Bangkok, 10210, Thailand. cmah2500@gmail.com.
authors.forename: Chulabhorn
authors.initials: C
authors.lastname: Mahidol
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography
keywords: Cancer screening; Cholangiocarcinoma; Early detection; Premalignant lesions; Tumor markers; Ultrasonography