Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma

Table 2 Representative diagnostic and predictive models developed for the differentiation of xanthogranulomatous cholecystitis and gallbladder carcinoma

Ref.	Study design/country	Diagnostic framework	Population	External validation	Performance	Principal limitations
Goshima et al[30], 2010	Retrospective, single-center/Japan	CT-based pattern assessment using five imaging findings	18 XGC/17 GBC	No	Accuracy 91% when ≥ 3 characteristic CT findings were present	Very small retrospective cohort; CT-based assessment only; no external validation
Xiao et al[28], 2022	Retrospective, single-center/China	Integrated clinical, laboratory, and radiological assessment	90 XGC/150 GBC	No	Mucosal line continuity and low-density border showed the highest discriminatory value	Single-center retrospective design; no independent validation; limited performance of individual features
Han et al[34], 2024	Retrospective, single-center/South Korea	Multiparametric magnetic resonance imaging scoring system	23 XGC/35 GBC	No	AUC 0.972	Small selected cohort restricted to wall-thickening-type GBC; no external validation
Fu et al[35], 2024	Retrospective, two-center/China	Machine-learning-assisted clinical, laboratory, and imaging nomogram	290 development/146 external validation	Yes, independent second center	Development AUC 0.936; consistent performance in external validation	Retrospective design; geographically restricted population; limited prospective clinical evaluation
Zhang et al[36], 2025	Retrospective, four-center/China	LIDGAX multimodal machine-learning model integrating clinical, laboratory, and imaging variables	1246 total; 674 training, 169 internal validation, 279 external testing, and 124 real-world evaluation	Yes, independent multicenter external testing	AUC 0.94 internal validation; 0.88 external testing; 0.95 real-world evaluation	Retrospective design; all centers from a single country/region; dependence on multimodal imaging availability; prospective impact on surgical outcomes not yet established

CT: Computed tomography; XGC: Xanthogranulomatous cholecystitis; GBC: Gallbladder carcinoma; AUC: Area under the curve.