Characteristics of Previously Undetected or Newly Emerging Cholangiocarcinoma Detected by Ultrasound Surveillance in an Endemic Area.

Authors

Nutsurang Promrach, Nannapat Nuangchamnong, Saowalak Chonyuen, Jitsupa Seetasarn, Pantajaree Hiranrat, Pooriput Waongenngarm, Surachate Siripongsakun

Published in

Asian Pacific journal of cancer prevention : APJCP. Volume 27. Issue 8. Pages 3037-3044. Aug 01, 2026. Epub Aug 01, 2026.

Abstract

Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with poor prognosis, largely due to delayed diagnosis. In endemic regions, abdominal ultrasonography is a rapid, inexpensive, and widely available surveillance tool that may support earlier detection. However, some lesions are missed at initial screening and detected only on follow-up. This study aimed to characterize the sonographic features and anatomical distribution of previously undetected or newly identified CCAs detected through an ultrasound-based surveillance program.
We retrospectively reviewed patients diagnosed with CCA through an abdominal ultrasound surveillance program in Nan Province, Thailand, between 2011 and 2017. Ultrasound findings and lesion locations were analyzed. All patients underwent confirmatory computed tomography or magnetic resonance imaging at Chulabhorn Hospital, with pathological confirmation of CCA. Descriptive and comparative analyses were performed.
Thirty-nine patients with 41 lesions were identified after a negative ultrasound examination 6 months earlier. Sonographic patterns included isolated hepatic masses, hepatic masses with bile duct dilatation, focal segmental bile duct dilatation, diffuse bile duct dilatation, and intraductal nodules. The most common presentations were isolated liver masses, liver masses with bile duct dilatation, and focal peripheral bile duct dilatation. Lesions were predominantly located in the peripheral intrahepatic bile ducts, especially second-order branches in hepatic segments VI and VII.
Previously undetected or newly identified CCAs during ultrasound surveillance most commonly appear as small hepatic nodules or focal bile duct abnormalities arising from peripheral and second-order intrahepatic bile ducts, particularly in posterior right hepatic segments VI-VII. These patterns may reflect both liver fluke-associated cholangiocarcinogenesis and technical limitations of ultrasonography in hepatic blind areas. Careful evaluation of these high-risk regions and awareness of subtle signs, including small hyperechoic nodules and focal ductal dilatation, may improve early detection and optimize surveillance in endemic populations.

PMID:
42663225
Bibliographic data and abstract were imported from PubMed on 28 Aug 2026.

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