Researchers reported that the best way to optimize tissue collection and biomarker testing for intracellular cholangiocarcinoma is to do so in a multidisciplinary setting. Their recommendations were published in The Oncologist. 

Studies suggest that around half of patients diagnosed with intrahepatic cholangiocarcinoma may have genetic alterations that are therapeutically targetable. However, treatment for advanced intrahepatic cholangiocarcinoma is mainly palliative and limited to chemotherapy. 

Biomarker testing has greatly aided oncologists in diagnosing cancer; however, challenges to its implementation remain, especially in rare cancers such as intrahepatic cholangiocarcinoma. In addition, standard image-guided liver biopsy and processing biomarker testing guidelines are currently unavailable. 

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“To address these barriers, a multidisciplinary panel of healthcare providers who are key in acquiring tissue, coordinating [next-generation sequencing] testing, and interpreting results—interventional oncologists, a gastroenterologist, medical oncologists, and pathologists—were convened to discuss best practices in optimizing tissue collection for biomarker characterization in [intrahepatic cholangiocarcinoma],” the authors of the study wrote.

Read more about cholangiocarcinoma etiology 

The authors of the study identified a few crucial areas in which tissue collection and processing can be particularly challenging: the lack of consensus on the best imaging modality for intrahepatic cholangiocarcinoma, the lack of a standardized biopsy technique for biomarker testing, and sampling bias. 

The multidisciplinary team involved in this study offered a few recommendations: the simultaneous use of fine needle aspiration and core needle biopsy for tissue acquisition, using an 18G needle for biopsies, and optimizing communication between members of the multidisciplinary team. 

The researchers involved in this study recommend that all patients with unresectable/metastatic intrahepatic cholangiocarcinoma undergo next-generation sequencing biomarker testing for the purpose of improving clinical outcomes. In addition, integrating cytological specimens into routine biomarker testing workflows can reduce the need for re-biopsy. 

“It is very important that all stakeholders involved in the care of patients with [intrahepatic cholangiocarcinoma] continue to coordinate their efforts to overcome challenges associated with image-guided biopsies for biomarker testing to improve patient outcomes,” the authors of the study concluded.


Madoff DC, Abi-Jaoudeh N, Braxton D, et al. An expert, multidisciplinary perspective on best practices in biomarker testing in intrahepatic cholangiocarcinomaOncologist. 2022;oyac139. doi:10.1093/oncolo/oyac139