Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2025; 31(11): 104170
Published online Mar 21, 2025. doi: 10.3748/wjg.v31.i11.104170
Cholangiocarcinoma: The era of liquid biopsy
Evgenia Kotsifa, Francesca Saffioti, Vasileios K Mavroeidis
Evgenia Kotsifa, The Second Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, General Hospital of Athens “Laiko”, Athens 11527, Greece
Francesca Saffioti, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
Francesca Saffioti, University College London Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and University College London, London NW3 2QG, United Kingdom
Francesca Saffioti, Division of Clinical and Molecular Hepatology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina 98124, Italy
Vasileios K Mavroeidis, Department of Transplant Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
Vasileios K Mavroeidis, Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
Vasileios K Mavroeidis, Department of HPB Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, United Kingdom
Author contributions: Kotsifa E did the literature search, analysis and interpretation of data, created the artwork and drafted the original manuscript; Saffioti F supervised the study and made critical revisions; Mavroeidis VK conceptualised, designed, supervised the study and made critical revisions; All authors prepared the final draft and approved the final version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vasileios K Mavroeidis, MD, PGDipClinEd, MSc, FRCS, FACS, FICS, FSSO, MFSTEd, MICR, Academic Research, Surgeon, Department of Transplant Surgery and Department of Gastrointestinal Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom. vasileios.mavroeidis@nhs.net
Received: December 12, 2024
Revised: January 28, 2025
Accepted: February 14, 2025
Published online: March 21, 2025
Processing time: 91 Days and 12.2 Hours
Abstract

Cholangiocarcinoma (CCA) is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract. The limitations of the current methods in the diagnosis of CCA highlight the urgent need for new, accurate tools for early cancer detection, better prognostication and patient monitoring. Liquid biopsy (LB) is a modern and non-invasive technique comprising a diverse group of methodologies aiming to detect tumour biomarkers from body fluids. These biomarkers include circulating tumour cells, cell-free DNA, circulating tumour DNA, RNA and extracellular vesicles. The aim of this review is to explore the current and potential future applications of LB in CCA management, with a focus on diagnosis, prognostication and monitoring. We examine both its significant potential and the inevitable limitations associated with this technology. We conclude that LB holds considerable promise, but further research is necessary to fully integrate it into precision oncology for CCA.

Keywords: Biliary tract cancer; Cholangiocarcinoma; Circulating tumour cells; Cell free DNA; Circulating tumour DNA; Circulating RNA; Biomarkers; Extracellular vesicles; Precision medicine

Core Tip: Cholangiocarcinoma (CCA) is an aggressive and heterogeneous malignancy that presents significant challenges in early detection, prognostication and monitoring using current diagnostic methods. Liquid biopsy (LB) emerges as a promising non-invasive technique, leveraging circulating tumour cells, cell-free DNA, circulating tumour DNA, RNA and extracellular vesicles as biomarkers. This review highlights the potential of LB to transform CCA management by improving early diagnosis, providing better prognostic insights and enabling dynamic patient monitoring. While LB shows substantial promise, critical limitations remain, necessitating further research to validate and optimise its integration into precision oncology for CCA.