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Primary sclerosing cholangitis (PSC) — confirmed by characteristic cholangiographic findi...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-PSC-CHOLANGIOCARCINOMA-PREVENTION
TypeRed flag
Statusreviewed 2026-05-18 | pending_clinical_signoff
DiseasesDIS-CHOLANGIOCARCINOMA DIS-CRC DIS-HCC
SourcesSRC-AASLD-HCC-2023 SRC-NCCN-COLON-2025 SRC-NCCN-HEPATOBILIARY

Red Flag Origin

DefinitionPrimary sclerosing cholangitis (PSC) — confirmed by characteristic cholangiographic findings on MRCP or ERCP (multifocal intra-/extra- hepatic biliary strictures with intervening dilatation, beaded appearance) and/or liver biopsy (concentric periductal fibrosis, onion-skin pattern). Includes PSC-IBD subgroup (very high risk for both CRC and cholangiocarcinoma) and PSC with dominant biliary stricture (additional cholangiocarcinoma risk requiring focused diagnostic workup). No current cholangiocarcinoma, gallbladder cancer, or HCC diagnosis. PSC is the strongest known risk factor for cholangiocarcinoma — lifetime risk ~10-15% (vs ~0.01% in general population); annual incidence ~0.5-1.5% per year. Gallbladder cancer risk also elevated ~10-fold. Cirrhotic PSC adds HCC risk in the general cirrhosis pattern. Surveillance with MRI/MRCP + CA 19-9 ± ERCP for dominant strictures enables earlier d...
Clinical directioninvestigate
Categoryother

Trigger Logic

{
  "any_of": [
    {
      "finding": "primary_sclerosing_cholangitis_diagnosis_confirmed",
      "value": true
    },
    {
      "finding": "primary_sclerosing_cholangitis_with_ibd",
      "value": true
    },
    {
      "finding": "primary_sclerosing_cholangitis_with_dominant_stricture",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

v0.3 chronic-condition prevention pilot — PSC. Prevention-persona RedFlag (CHARTER §3 amended 2026-05-18 Path A, HCP-mediated). Fires when patient profile shows confirmed PSC (any trigger) AND no current cholangiocarcinoma / gallbladder cancer / HCC diagnosis. Engine routes to PreventionPlan with 2 tracks: intensified imaging surveillance (annual MRI/MRCP + CA 19-9 ± ERCP for dominant strictures, annual colonoscopy if PSC-IBD) (IND-PSC-CHOLANGIOCARCINOMA-PREVENTION-SURVEILLANCE) as standard; routine q2-3y imaging surveillance (IND-PSC-CHOLANGIOCARCINOMA- PREVENTION-OBSERVATION) as alternative. Disease anchors verified 2026-05-18: DIS-CHOLANGIOCARCINOMA exists as a KB entity. Anchored PSC primarily to DIS-CHOLANGIOCARCINOMA (per advisor recommendation). DIS-CRC included for PSC-IBD subgroup; DIS-HCC included for cirrhotic PSC HCC risk. Evidence base: - **PSC → cholangiocarcinoma:** lifetime risk ~10-15%; annual incidence ~0.5-1.5%/year (multiple population-based registry studies including Bergquist et al. Gastroenterology 2002, Boberg et al. Hepatology 2009). - **PSC → gallbladder cancer:** ~10-fold elevated relative risk; ~3-14% lifetime risk depending on cohort. Gallbladder polyp...

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