Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand.
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
BMJ Open. 2019 Mar 20;9(3):e023217. doi: 10.1136/bmjopen-2018-023217.
To assess associations between periductal fibrosis (PDF) and bile duct dilatation (BDD) in ultrasonography (US) screening of population at risk of cholangiocarcinoma (CCA) due to residence in an endemic area for CCA survival rates are low, and early identification of risk factors is essential. BDD is one symptom that can identify patients at risk of CCA. Detection of PDF by US can also identify at-risk patients, at an earlier stage of CCA development. Identification of association between PDF and BDD will inform screening practices for CCA risk, by increasing the viability of PDF screening for CCA risk.
Nine tertiary care hospitals in Northeast Thailand.
Cross-sectional study.
Study subjects in the Cholangiocarcinoma Screening and Care Program (CASCAP) in Northeast Thailand. CASCAP inclusion criteria are all residents of Northeast Thailand aged ≥40 years. Participants are recruited through CCA screening centres and through primary healthcare units. So far, 394 026 have been enrolled.
PDF and BDD were identified through US. PDF was categorised into three groups, PDF1, 2 and 3, depending on their high echo locality in the peripheral, segmental and main bile duct, respectively. Associations between PDF and BDD were determined by adjusted OR and 95% CI using multiple logistic regression.
BDD was found in 6.6% of PDF3, 1.7% of PDF2 and 1.4% of PDF1 cases. Among PDF cases, especially in PDF3, BDD was found in men more than in women (8.9% and 4.6%, respectively). Compared with non-PDF, the association between PDF3 and BDD was highly significant (adjusted OR=5.74, 95% CI 4.57 to 7.21, p<0.001).
Our findings reveal that there is a relationship between PDF and BDD, which is associated with CCA. Therefore, PDF can also be an indicator for suspected CCA diagnosis through US.
评估人群中因居住在胆管癌高发地区而进行超声筛查时，管周纤维化（PDF）与胆管扩张（BDD）之间的相关性。由于胆管癌的生存率较低，因此早期识别危险因素至关重要。BDD 是可以识别胆管癌高危患者的一个症状。通过 US 检测 PDF 也可以在胆管癌发展的早期阶段识别高危患者。确定 PDF 与 BDD 之间的关联将为胆管癌风险筛查提供信息，从而提高通过 PDF 筛查胆管癌风险的可行性。
泰国东北部的 9 家三级保健医院。
横断面研究。
泰国东北部胆管癌筛查和护理计划（CASCAP）的研究对象。CASCAP 的纳入标准是年龄≥40 岁的所有泰国东北部居民。参与者通过胆管癌筛查中心和初级保健单位招募。迄今为止，已有 394026 人入组。
通过 US 识别 PDF 和 BDD。根据其在周围、节段和主胆管中的高回声位置，将 PDF 分为 3 组（PDF1、2 和 3）。通过多因素逻辑回归，用调整后的比值比（OR）和 95%CI 确定 PDF 和 BDD 之间的关联。
在 PDF3 中发现了 6.6%的 BDD，在 PDF2 中发现了 1.7%，在 PDF1 中发现了 1.4%。在 PDF 病例中，尤其是在 PDF3 中，BDD 在男性中比女性更常见（分别为 8.9%和 4.6%）。与非 PDF 相比，PDF3 与 BDD 之间存在高度显著的关联（调整后的 OR=5.74，95%CI 4.57 至 7.21，p<0.001）。
我们的研究结果表明，PDF 与 BDD 之间存在关联，而 BDD 与胆管癌相关。因此，通过 US 也可以将 PDF 作为疑似胆管癌诊断的指标。
