We would like to thank Dr. Fujita for the positive comments. We agree that a sensitivity of 67% and specificity of 96% would be useful as a test used in the clinic. 1 In regard to cost, we also agree that this is a very important consideration, along with complexity of the test and feasibility for a clinical laboratory to perform the test. These were considerations that we contemplated throughout the development of the project. For example, at an earlier stage of the project, we experimented with a quicker, but more expensive, method to extract extracellular vesicles. We decided to utilize, thoroughly test, and eventually implement ultracentrifugation for simplicity and cost reasons.Early diagnosis of cholangiocarcinoma, as accurately pointed out by Dr. Fujita, is the cornerstone of survival. Though the sensitivity of the microRNA (miR) panel for all comers is not dramatically different than the sensitivity of cancer antigen 19-9 (CA19-9), we noted that the panel is more sensitive than CA19-9 for early cancers. There is hope that further testing of the panel in larger cohorts will validate this finding and that the panel will prove its utility in detecting early cancers.Some of the miR species on the panel (in particular, miR-191 and 2486-3p) have been associated with cancer in the past. 2,3 However, our findings are limited to the presence of these miR species in extracellular vesicles in bile. It would be of interest to further the study of these miR species to unravel their mechanistic involvement in cancers of the liver. In addition, as Dr. Fujita indicated, a study to look at these miR species in bile from patients with other small lesions (such as small hepatocellular carcinomas) would further shed light into the utility of the reported panel in differentiating the etiology of small liver masses found at imaging.