Molecular diagnostics as the clinical standard in cholangiocarcinoma and hepatocellular carcinoma: a new era of precision oncology

Abstract

The management of hepatobiliary malignancies has undergone a profound transformation, shifting from an empiric, uniform systemic approach to an increasingly stratified paradigm of precision oncology. Advances in molecular characterization, particularly through next-generation sequencing (NGS), have identified actionable alterations in a clinically relevant proportion of patients with cholangiocarcinoma (CCC) and are increasingly informing biomarker-driven treatment strategies in hepatocellular carcinoma (HCC). This review summarizes current clinical standards in molecular diagnostics, with a focus on FGFR2 testing, the implications of CTNNB1 mutations for the immune microenvironment, and the emerging role of liquid biopsy in monitoring clonal evolution and therapeutic resistance.