Teleconsultation ultrasonography: a new weapon to combat cholangiocarcinoma

Abstract

Although cholangiocarcinoma (CCA) is usually a rare cancer, in northeast Thailand it kills 20 000 or more people every year. The prognosis is very poor owing to late stage diagnosis, with palliative treatment often representing the only option. In this area of predominantly rural Thailand, CCA is associated with infection with the liver fluke, Opisthorchis viverrini, which is classified as a group 1 carcinogen. Up to 6 million Thais are infected with this fluke. The Cholangiocarcinoma Screening and Care Program (CASCAP) was initiated in 2014 with the aim of detecting early stage CCA, allowing curative surgery, by using ultrasound (US) screening of prospectively 500 000 at risk individuals. In order to assess the massive number of radiological images, a teleconsultation system was set-up. This allows US images to be sent to a dedicated server where they can be viewed by an expert radiologist who then provides a provisional diagnosis, recommending more advanced diagnostic techniques (CT and MRI) for suspected cases. To date, 250 000 people have been screened, and 2000 cases of CCA diagnosed. This innovative information transfer procedure will also be made available to Laos, Cambodia and Vietnam, where O. viverrini infection is also common.

Keywords: cholangiocarcinoma; teleconsultation ultrasonography.

Figure 1

Periductal infiltrating cholangiocarcinoma (PI-CCA). Ultrasonographic image showing dilatation of the intrahepatic duct in the left liver lobe (arrows) of a 71-year-old man. Further imaging showed dilatation of the bile duct in keeping with PI-CCA in the left lobe liver.

Figure 2

Diagram showing the CASCAP MD KKU Solution workflow for ultrasound image collection and teleconsultation. CASCAP, Cholangiocarcinoma Screening and Care Program; DICOM, digital communication in medicine; PACS, picture archiving and communication system; US, ultrasound; VPN, virtual private network.