Abdominal Ultrasonographic Findings of Risk Population in Cholangiocarcinoma Ultrasound Screening Unit: One-Stop-Service

Main Article Content

Supatcha Deewangphon
Nittaya Chamadol
Narong Khuntikeo
Watcharin Loilome


Background and objective: The only potentially curative treatment for patients with early-stage cholangiocarcinoma (CCA) is surgery. Most of CCA patients go to the physician at late stage or developing jaundice. The ultrasound is an important tool in CCA screening for detecting early-stage CCA. The purpose of the present study was to define the prevalence of CCA and identify abdominal ultrasonographic findings.

Material and methods: This retrospectively descriptive study, the authors reviewed the medical records and abdominal ultrasonographic findings of CCA risk population in CCA ultrasonography screening unit: One-Stop-Service.

Results: Among 538 risk populations, there were 26.4% male and female 73.6%. The prevalence of CCA is 0.2%. There were 72.9% with abnormal ultrasonographic findings (392 cases, 78.2% male, 71% female). In addition, ultrasonography diagnosis demonstrated the appearance for suspicious CCA in 1.1% of cases (6/358) , which 2 cases had mass plus dilate intrahepatic duct (IHD), 2 cases had only mass and 2 cases had only dilate IHD. There were 2 fatty liver or normal liver each, and there was either cirrhosis or liver parenchymal change. One was diagnosed to highly suspicious for CCA by computerized tomography (CT), which the pathologically proven to have CCA. 2 cases were CT diagnosed to suspicious for CCA or hepatoma (HCC), which one case was MRI diagnosed to HCC (the pathologically proven to have cirrhosis with regenerative nodule) and one case the pathologically proven to have HCC. 3 cases were CT diagnosed to have hemangioma, gallstone plus cholangitis and distal common bile duct stenosis. Moreover, there were 37.4% fatty liver and 16.5% periductal fibrosis.

Conclusion: The prevalence of CCA has been high in the CCA ultrasound screening unit. The CCA screening by ultrasound is very useful in order to identify the early CCA cases, which will benefit for the patients interm of diagnosis and treatment. The ultrasound used to suggest additional CT or MRI.


Download data is not yet available.

Article Details

How to Cite
Deewangphon S, Chamadol N, Khuntikeo N, Loilome W. Abdominal Ultrasonographic Findings of Risk Population in Cholangiocarcinoma Ultrasound Screening Unit: One-Stop-Service. SRIMEDJ [Internet]. 2022 Aug. 30 [cited 2023 Jan. 30];37(4):373-87. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/254712
Original Articles


Khuntikeo N. Cholangiocarcinoma in Thailand. Khonkaen:Klungnanavittaya Press;2021.

Kirstein MM, Vogel A. Epidemiology and risk ractors of cholangiocarcinoma. Visc Med 2016;32:395-400.

Alsaleh M, Leftley Z, Barbera TA, Sithithaworn P, Khuntikeo N, Loilome W, et al. Cholangiocarcinoma: a guide for the nonspecialist. Int J Gen Med 2019;12:13-23.

International Health Policy Program. Disability-Adjusted Life Years: DALYs 2014. Nonthaburi: The graphic systems; 2017.

Imsamran W, Pattatang A, Supaattagorn P, Chiawiriyabunya I, Namthaisong K, Wongsena M, et al. Cancer in Thailand Vol.IX, 2013-2015. Bangkok: Cancer Registry Unit. National Cancer Institute; 2018.

Rojanamatin J, Ukranun W, Supaattagorn P, Chaiwiriyabunya I, Wongsena M, Chaiwerawattana A, et al., editors. Cancer in Thailand Vol.X, 2016-2018. Bangkok: Cancer Registry Unit. National Cancer Institute; 2021

Virani S, Bilheem S, Chansaard W, Chitapanarux I, Daoprasert K, Khuanchana S, et al. National and subnational population-based incidence of cancer in Thailand: assessing cancers with the highest burdens. Cancers 2017;9(8):e108. doi: 10.3390/cancers9080108.

Khuntikeo N. Current concept in management of cholangiocarcinoma. Srinagarind Med J 2012;20(3):143-9.

Sripa B, Kaewkes S, Sithithaworn P, Mairiang E, Laha T, Smout M, et al. Neglected Diseases: liver fluke induces cholangiocarcinoma. PLoS Medicine 2007;4(7):1148-55.

Khuntikeo N, Pugkhem A. Current treatment of cholangiocarcinoma. Srinagarind Med J 2012;27Suppl (cholangiocarcinoma):S340-50.

Tatipun A. Management in cholangiocarcionoma. Srinagarind Med J 2015;30Suppl 5:S30-5.

Bhudhisawasdi V, Khuntikeo N, Chur-in S, Pugkhem A, Talabnin C, Wongkham S. Cholangiocarcinoma: experience of Srinagarind hospital. Srinagarind Med J 2012;27 Suppl (cholangiocarcinoma):S331-9.

Chamadol N, Pairojkul C, Khuntikeo N, Laopaiboon V, Loilome W, Sithithaworn P, et al. Histological confirmation of periductal fibrosis from ultrasound diagnosis in cholangiocarcinoma patients. Hepatobiliary Pancreat Sci 2014;21:316-322

Chamadol N. Imaging in cholangiocarcinoma. 2nded.Khonkaen: KhonkaenUniversity Press; 2016.

Khuntikeo N, Yongvanit P. Conceptual framework of health policy and strategies to administer and manage cholangiocarcinoma systematically and effectively. Srinagarind Med J 2012;27 suppl (cholangiocarcinoma):S422-6.

Khuntikeo N, Chamadol N, Youngvanit P, Sithithaworn P, Thinkhamrop B, Loilome W. Health system development for screening, early diagnosis and management of cholangiocarcinoma in Northeast, Thailand [Internet]. Bangkok: Health Systems Research Institute; 2018 [cited 2021 May 3]. Available from: https://kb.hsri.or.th/dspace/bitstream/handle/11228/4839/hs2386.pdf?sequence=3&isAllowed=y

Patel N, Benipal B. Incidence of cholangiocarcinoma in the USA from 2001 to 2015: A US cancer statistics analysis of 50 states. Cureus2019;11(1):e3962. doi: 10.7759/cureus.3962

Saha SK, Zhu AX, Fuchs CS, Brooks GA. Forty-year trends in cholangiocarcinoma incidence in the U.S.: intrahepatic disease on the rise. The Oncologist 2016;21:594-9.

Meza-Junco J, Montano-Loza AJ, Ma M, Wong W, Sawyer MB, Bain VJ. Cholangiocarcinoma: Has there been any progress? Can J Gastroenterol2010;24(1):52-7.

Sungkasuborn P, Siripongsakun S, Akkarachinorate K, Vidhyarkorn S, Worakitsitisatorn A, Sricharunrat T, et al. 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. BMC Cancer 2016;16:346. doi 10.1186/s12885-016-2390-2

Archavachalee N. Efficiency of cholangiocarcinoma detection in high risk populations of Phonthong district, Roi-et province according to the cholangiocarcinoma screening and care program (CASCAP). Journal of the office of DPC 7 Khonkaen2018;25(2):58-66.

Sriphan I. Screening cholangiocarcinoma by ultrasound at Kham tale so hospital. The JODPC10 2019;17(2):19-27.

Munpolsri N, Phuthiwut W, Nanthanangkul S, Usah P, Pilatan W. Summary of the performance of cholangiocarcinoma screening project in public health region 8 2019 [Internet]. Udonthani: Udonthani Cancer Hospital Department of medical Services Ministry of Public Health; 2019 [cited 2020 Dec 2]. Available from : https://www.udch.go.th/uploads/doc/CASCAP/CASCAP2562.pdf

Khuntikeo N, Koonmee S, Sangiamwibool P, Chamadol N, LaopaiboonV,Titapun A, et al. A comparison of the proportion of early stage cholangiocarcinoma found in an ultrasound-screening program compared to walk-in patients. HPB 2020;22 (6):874-883.

Dhanasekaran R, Hemming AW, Zendejas I, George T, Nelson DR, Soldevila-Pico C, et al. Treatment outcomes and prognostic factors of intrahepatic cholangiocarcinoma. Oncol Rep 2013; 29:1259-67. doi: 10.3892/or.2013.2290. PubMed PMID: 23426976.

Siripongsakun S, Vidhyakorn S, Charuswattanakul S, Mekraksakit P, Sungkasubun P, Yodkhunnathum N, et al. Ultrasound surveillance for cholangiocarcinoma in an endemic area: a prove of survival benefits. Journal of Gastroenterology and Hepatology 2018;33(7):1383-8.

Chaiwerawattana A, Sukornyothin S, Karalak A, Kuhaprema T. Guidelines for screening, diagnosis and treatment of liver and bile duct cancer. 2nd ed. Bangkok: National Cancer Institute Department of Medical Services Ministry of Public Health;2011

Chamadol N, Khuntikeo N, Thinkhamrop B, Thinkhamrop K, Suwannatrai AT, Kelly M, et.al. Association between periductal fibrosis and bile duct dilation among a population at high risk of cholangiocarcinoma: a cross-sectional study of cholangiocarcinoma screening in Northest Thailand. BMJ 2019;9:e023217. doi:10.1136/bmjopen-2018-023217

Vannakaew N. Analysis type of ultrasound of liver and biliary system from CASCAP Projectin Don mod daeng district, Ubonratchathani province in the year 2014-2015. The JODPC10 2017;15(2):5-18.

Rungputthigul V. Factors influenced with periductal fibrosis of hepatobiliary tract in Wangtong sub-district, Phakdichumphon district, Chaiyaphum province. DPC 9 2018;24(2):36-45.

Mairiang E, Laha T, Bethony JM, Thinkhamrop B, Kaewkes S, Sithithaworn P, at al. Ultrasonography assessment of hepatobiliary abnormalities in 3359 subjects with Opisthorchis viverrini infection in endemic areas of Thailand. Parasitol Int 2012;61:208-11. doi: 10.1016/j.parint.2011.07.009. PubMed PMID: 21771664.

Intajarurnsan S, Khuntikeo N, Chamadol N, Thinkhamrop B, Promphet S. Factors associated with periductal fibrosis diagnosed by ultrasonography screening among a high risk population for cholangiocarcinoma in Northeast Thailand. Asian Pac J Cancer Prev 2016;17(8):4131-6.

Worasith C, Wangboon C, Duenngai K, Kiatsopit N, Kopolrat K, Techasen A, et al. Comparing the performance of urine and copro-antigen detection in evaluating Opisthorchis viverrini infection in communities with different transmission levels in Northeast Thailand. PLoS Negl Trop Dis 2019; 13(2):e0007186.

Khuntikeo N, Chamadol N, Yongvanit P, Loilome W, Namwat N, Sithithaworn P, et al. Cohort profile: cholangiocarcinoma screening and care program (CASCAP). BMC Cancer 2015;15:459. doi:10.1186/s12885-015-1475-7

Cheepcharoenrat N, Nethan C. Raw fish consumption behavior and Opisthorchis viverrini Infection after cholangiocarcinoma screening by ultrasound in Yasothron province: a randomized controlled trail. Srinagarind Med J 2020;35(4):385-9.

Khuntikeo N, TitapunA, Loilome W, YongvanitP, Thinkhamrop B, Chamadol N, et al. Current perspectives on Opisthorchiasis control and cholangiocarcinoma detection in Southeast Asia. Front. Med. 2018; 5:117. doi:10.3389/fmed.2018.00117

Oshibuchi M, Nishi F, Sato M, Ohtake H, Okuda K. Frequency of abnormalities detected by abdominal ultrasound among Japanese adults. J GastroenterolHepatol 1991;6:165-8.

Rungsinaporn K, Phaisakamas T. Frequency of abnormalities detected by upper abdominal ultrasound. J Med Assoc Thai 2008;91(7):1072-5.

Kojima S, Watanabe N, Numata M, Ogawa T, Matsuzaki S. Increase in the prevalence of fatty liver in Japan over the past 12 years: analysis of clinical background. J Gastroenterol 2003;38:954-61.

Li J, Zou B, Yeo YH, Feng Y, Xie X, Lee DH, et al. Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2019;4(5):389-98.

Summart U, Thinkhamrop B, Chamadol N, Khuntikeo N, Songthamwat M, Kim CS. Gender differences in the prevalence of nonalcoholic fatty liver disease in the Northeast of Thailand: a population-based cross-sectional study. F1000Res 2017;6:1630. doi: 10.12688/f1000research.12417.2. PubMed PMID: 29093809.

Wongjarupong N, Assavapongpaiboon B, Susantitaphong P, Cheungpasitporn W, Treeprasertsuk S, Rerknimitr R, et al. Non-alcoholic fatty liver disease as a risk factor for cholangiocarcinoma: a systematic review and meta-analysis. BMC Gastroenterol 2017;17:149. doi: 10.1186/s12876-017-0696-4. PubMed PMID: 29216833.

Chitturi S, Farrell GC. Etiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis 2001; 21(1):27-41.

Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2015;149(2):389-97.

Camilleri M, Malhi H, Acosta A. Gastrointestinal complications of obesity. Gastroenterology 2017; 152(7):1656-1670.

Chamadol N, Laopaiboon V, Srinakarin J, Loilome W, Yongvanit P, Thinkhamrop B, Khuntikeo N. Teleconsultation ultrasonography: a new weapon to combat cholangiocarcinoma. ESMO Open 2017;2:e000231. doi: 10.1136/esmoopen-2017-000231. PMID: 29209530.

Wongrajit K. The three doctors policy: three doctors to each family. The 9th planning and evaluation committee meeting 2021; 2021 Dec 1; Thapsakae hospital Prachuap Khiri Khan