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Serenari M, Berti D, Rivera B, Newhook TE, Kristjanpoller W, Ruzzenente A, Okuno M, De Bellis M, Panettieri E, Ahmad MU, Merlo I, De Rose AM, Nishino H, Sinnamon AJ, Donadon M, Hauger MS, Guevara OM, Munoz C, Denbo J, Chun YS, Tran Cao HS, Sanchez Claria R, Tzeng CWD, De Aretxabala X, Vivanco M, Brudvik KW, Seo S, Pekolj J, Poultsides GA, Anaya DA, Torzilli G, Giuliante F, Guglielmi A, Vinuela E, Vauthey JN, Cescon M, Vega EA. Optimizing Outcomes in Gallbladder Cancer: Identifying Predictors of Futile Up-Front Surgery in a Global Multi-center Study. Ann Surg Oncol 2025; 32:4374-4382. [PMID: 40050485 DOI: 10.1245/s10434-025-17083-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 02/07/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Gallbladder cancer (GBC) has a poor prognosis, particularly in advanced stages, with surgery often offering limited survival benefit. This study aimed to identify risk factors for futile surgery (FS), defined as procedures followed by early recurrence or death. METHODS An international cohort of 788 patients who underwent up-front GBC surgery across 18 centers was analyzed. Futility was defined as recurrence within 5 months or death within 90 days after oncological surgery. A multivariate model was built, and an online calculator was developed to predict the probability of FS. RESULTS A total of 107 patients (13.6%) experienced FS, with a median survival of only 6.8 months, compared with 57.4 months for nonfutile cases. The key risk factors identified were the T3-T4 tumor stage (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.30-3.71), lymph node involvement (OR 1.91; 95% CI 1.22-2.98), and multivisceral resection (OR 2.25; 95% CI 1.28-3.94). Incidental GBC diagnoses showed a lower risk of FS (OR 0.41; 95% CI 0.25-0.67). The predictive model had a strong discriminative ability (c-statistic: 0.749). Decision curve analysis demonstrated the superiority of the multivariate model over individual predictors. CONCLUSIONS Refining patient selection can reduce futile surgeries in GBC. The predictive model provides a valuable online tool ( https://aicep.website/?cff-form=25 ) to improve decision-making and outcomes by minimizing unnecessary interventions.
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Affiliation(s)
- Matteo Serenari
- Hepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Davide Berti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Belen Rivera
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Werner Kristjanpoller
- Department of Industries, Universidad Tecnica Federico Santa Maria, Valparaiso, Chile
| | - Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Masayuki Okuno
- Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mario De Bellis
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - M Usman Ahmad
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Ignacio Merlo
- General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agostino Maria De Rose
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Andrew J Sinnamon
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Marit S Hauger
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Cesar Munoz
- UGI and HPB Surgery Unit, Hospital Regional de Talca, Universidad Catolica del Maule, Talca, Chile
| | - Jason Denbo
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodrigo Sanchez Claria
- General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xabier De Aretxabala
- Gallbladder Consortium Chile, Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital and Clinica Alemana de Santiago, Santiago, Chile
| | - Marcelo Vivanco
- Gallbladder Consortium Chile, Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital and Clinica Alemana de Santiago, Santiago, Chile
| | - Kristoffer W Brudvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Juan Pekolj
- General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli" IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, Verona, Italy
| | - Eduardo Vinuela
- Gallbladder Consortium Chile, Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital and Clinica Alemana de Santiago, Santiago, Chile
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matteo Cescon
- Hepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Eduardo A Vega
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Surgery, Saint Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Serenari M, Rivera B, Vega EA. Reply to the Letter to the Editor Regarding "Optimizing Outcomes in Gallbladder Cancer: Identifying Predictors of Futile Up-Front Surgery in a Global Multi-Center Study". Ann Surg Oncol 2025:10.1245/s10434-025-17391-w. [PMID: 40287892 DOI: 10.1245/s10434-025-17391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Accepted: 04/13/2025] [Indexed: 04/29/2025]
Affiliation(s)
- Matteo Serenari
- Hepato-Biliary Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Belen Rivera
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eduardo A Vega
- Department of Surgery, Saint Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Rana P, Kalage D, Soundararajan R, Gupta P. Update on the Role of Imaging in the Diagnosis, Staging, and Prognostication of Gallbladder Cancer. Indian J Radiol Imaging 2025; 35:218-233. [PMID: 40297115 PMCID: PMC12034421 DOI: 10.1055/s-0044-1789243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2025] Open
Abstract
Gallbladder cancer (GBC) is a highly aggressive malignancy with dismal prognosis. GBC is characterized by marked geographic predilection. GBC has distinct morphological types that pose unique challenges in diagnosis and differentiation from benign lesions. There are no specific clinical or serological markers of GBC. Imaging plays a key role not only in diagnosis and staging but also in prognostication. Ultrasound (US) is the initial test of choice that allows risk stratification in wall thickening and polypoidal type of gallbladder lesions. US findings guide further investigations and management. Computed tomography (CT) is the test of choice for staging GBC as it allows comprehensive evaluation of the gallbladder lesion, liver involvement, lymph nodes, peritoneum, and other distant sites for potential metastases. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography allow better delineation of the biliary system involvement. Contrast-enhanced US and advanced MRI techniques including diffusion-weighted imaging and dynamic contrast-enhanced MRI are used as problem-solving tools in cases where distinction from benign lesion is challenging at US and CT. Positron emission tomography is also used in selected cases for accurate staging of the disease. In this review, we provide an up-to-date insight into the role of imaging in diagnosis, staging, and prognostication of GBC.
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Affiliation(s)
- Pratyaksha Rana
- Department of Radiology, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Daneshwari Kalage
- Department of Radiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, Nagpur, Maharashtra, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Okasha HH, Gadour E, Atalla H, AbdEl-Hameed OA, Ezzat R, Alzamzamy AE, Ghoneem E, Matar RA, Hassan Z, Miutescu B, Qawasmi A, Pawlak KM, Elmeligui A. Practical approach to linear endoscopic ultrasound examination of the gallbladder. World J Radiol 2024; 16:184-195. [PMID: 38983839 PMCID: PMC11229944 DOI: 10.4329/wjr.v16.i6.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/03/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
The gallbladder (GB) is a susceptible organ, prone to various pathologies that can be identified using different imaging techniques. Transabdominal ultrasound (TUS) is typically the initial diagnostic method due to its numerous well-established advantages. However, in cases of uncertainty or when a definitive diagnosis cannot be established, computed tomography (CT) or magnetic resonance imaging may be employed to provide more detailed information. Nevertheless, CT scans may sometimes offer inadequate spatial resolution, which can limit the differentiation of GB lesions, particularly when smaller yet clinically relevant abnormalities are involved. Conversely, endoscopic ultrasound (EUS) provides higher frequency compared to TUS, superior spatial resolution, and the option for contrast-enhanced harmonic imaging, enabling a more comprehensive examination. Thus, EUS can serve as a supplementary tool when conventional imaging methods are insufficient. This review will describe the standard EUS examination of the GB, focusing on its endosonographic characteristics in various GB pathologies.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Eyad Gadour
- Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, Ahsa 31982, Saudi Arabia
- Department of Medicine, School of Medicine, Zamzam University College, Khartoum 11113, Sudan
| | - Hassan Atalla
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Omar AbdAllah AbdEl-Hameed
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Reem Ezzat
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71511, Egypt
| | - Ahmed Elsayed Alzamzamy
- Department of Gastroenterology and Heptology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11728, Egypt
| | - Elsayed Ghoneem
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Rasha Ahmad Matar
- Department of Gastroenterology and Advance Endoscopy, Sultant Qaboos Comprehensive Cancer Care and Research Centre, Muscat 0961, Oman
| | - Zeinab Hassan
- Department of Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
- Advanced Regional Research Centre in Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 30041, Romania
| | - Ayman Qawasmi
- Department of Gastroenterology, Al-Makassed Islamic Charitable Society Hospital, Cairo 11124, Egypt
| | - Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Canada
| | - Ahmed Elmeligui
- Department of Gastroenterology, Southend University Hospital, Essex SS2 6XT, United Kingdom
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Lee SH, Song SY. Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications. Cancers (Basel) 2024; 16:1761. [PMID: 38730713 PMCID: PMC11083053 DOI: 10.3390/cancers16091761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Biliary tract cancers (BTCs), including intrahepatic, perihilar, and distal cholangiocarcinomas, as well as gallbladder cancer, are a diverse group of cancers that exhibit unique molecular characteristics in each of their anatomic and pathological subtypes. The pathological classification of BTCs compromises distinct growth patterns, including mass forming, periductal infiltrating, and intraductal growing types, which can be identified through gross examination. The small-duct and large-duct types of intrahepatic cholangiocarcinoma have been recently introduced into the WHO classification. The presentation of typical clinical symptoms, as well as the extensive utilization of radiological, endoscopic, and molecular diagnostic methods, is thoroughly detailed in the description. To overcome the limitations of traditional tissue acquisition methods, new diagnostic modalities are being explored. The treatment landscape is also rapidly evolving owing to the emergence of distinct subgroups with unique molecular alterations and corresponding targeted therapies. Furthermore, we emphasize the crucial aspects of diagnosing BTC in practical clinical settings.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Si Young Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03772, Republic of Korea
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Zhou S, Han S, Chen W, Bai X, Pan W, Han X, He X. Radiomics-based machine learning and deep learning to predict serosal involvement in gallbladder cancer. Abdom Radiol (NY) 2024; 49:3-10. [PMID: 37787963 DOI: 10.1007/s00261-023-04029-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Our study aimed to determine whether radiomics models based on contrast-enhanced computed tomography (CECT) have considerable ability to predict serosal involvement in gallbladder cancer (GBC) patients. MATERIALS AND METHODS A total of 152 patients diagnosed with GBC were retrospectively enrolled and divided into the serosal involvement group and no serosal involvement group according to paraffin pathology results. The regions of interest (ROIs) in the lesion on all CT images were drawn by two radiologists using ITK-SNAP software (version 3.8.0). A total of 412 features were extracted from the CT images of each patient. The Mann‒Whitney U test was applied to identify features with significant differences between groups. Seven machine learning algorithms and a deep learning model based on fully connected neural networks (f-CNNs) were used for radiomics model construction. The prediction efficacy of the models was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS Through the Mann‒Whitney U test, 75 of the 412 features extracted from the CT images of patients were significantly different between groups (P < 0.05). Among all the algorithms, logistic regression achieved the highest performance with an area under the curve (AUC) of 0.944 (sensitivity 0.889, specificity 0.8); the f-CNN deep learning model had an AUC of 0.916, and the model showed high predictive power for serosal involvement, with a sensitivity of 0.733 and a specificity of 0.801. CONCLUSION Radiomics models based on features derived from CECT showed convincing performances in predicting serosal involvement in GBC.
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Affiliation(s)
- Shengnan Zhou
- Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Shaoqi Han
- General Surgery Department, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Weijie Chen
- General Surgery Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xuesong Bai
- General Surgery Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Weidong Pan
- Radiology Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xianlin Han
- General Surgery Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Xiaodong He
- General Surgery Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Adam KM, Abdelrahim EY, Doush WM, Abdelaziz MS. Clinical presentation and management modalities of gallbladder cancer in Sudan: A single-center study. JGH Open 2023; 7:365-371. [PMID: 37265936 PMCID: PMC10230110 DOI: 10.1002/jgh3.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/11/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIM Gallbladder cancer (GBC) is a rare and highly aggressive malignancy characterized by late presentation of nonspecific symptoms, poor curability, and high mortality. The gold standard for effective treatment depends on early detection and surgical excision. Hence, the aim of this study was to determine the patterns of clinical presentation and management modalities to reach excellent practice. METHODS A retrospective study was conducted during the period from May 2021 to April 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, on 50 patients with GBC who underwent a preoperative clinical and radiological evaluation to enable the use of appropriate surgical and oncological approaches. RESULTS GBC was more prevalent in females in this series where all had GBC (68%), in the ratio 2:1. Distribution of patients according to age ranged between 61 and 75 years, representing 44% of patients. Abdominal pain, nausea, and vomiting were present in 40% of patients. Fifty-six percent of patients resided in urban areas. Transabdominal ultrasound (TUS) with CT scan diagnosed GBC in 54% of patients. GBC was metastatic (stage IV) in 52% of patients. Based on preoperative decision by a multidisciplinary team (MDT), 62% of patients had palliative nonsurgical oncological treatment. Histopathological analysis of the resected GBC showed adenocarcinoma in 74% of cases. The inoperable patients (42%) were treated palliativelly with endoscopic retrograde cholangiopancreatography/systemic chemotherapy. Finally, the overall mortality rate was 56%. CONCLUSIONS Accurate early clinical diagnosis and advanced radiological modalities with curative surgical approaches including clear surgical resection margins and systemic oncological therapies will potentially help in improving GBC survival outcomes.
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Affiliation(s)
- Khatab M. Adam
- Department of Gastroenterological SurgeryIbn Sina Specialized HospitalKhartoumSudan
| | | | - Wael Mohialddin Doush
- Department of Gastroenterological SurgeryIbn Sina Specialized HospitalKhartoumSudan
- Department of Surgery, Faculty of Medicine and Health SciencesOmdurman Islamic UniversityKhartoumSudan
| | - Muataz S. Abdelaziz
- Department of Surgery, Faculty of Medicine and Health SciencesOmdurman Islamic UniversityKhartoumSudan
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Tamura T, Ashida R, Kitano M. The usefulness of endoscopic ultrasound in the diagnosis of gallbladder lesions. Front Med (Lausanne) 2022; 9:957557. [PMID: 36106323 PMCID: PMC9465250 DOI: 10.3389/fmed.2022.957557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022] Open
Abstract
Gallbladder tumors are neoplastic lesions; however, it can be difficult to distinguish between benign and malignant gall bladder tumors before surgery, although endoscopic ultrasound (EUS) is useful for differentiation. Fundamental B mode EUS (FB-EUS) and contrast-enhanced harmonic EUS (CH-EUS) are reported to be useful for the diagnosis of gallbladder tumor because they allow evaluation of polypoid lesion and gallbladder wall thickening. Scoring systems based on FB-EUS imaging are available for the diagnosis of malignant gallbladder polypoid lesions. The characteristic findings of malignant gallbladder polypoid lesions on CH-EUS include the presence of irregular intratumoral vessels and perfusion defects. The characteristic findings of malignant gallbladder wall thickening on FB-EUS include wall thickening >12 mm, hypoechoic internal echogenicity, inhomogeneous internal echo pattern, and disrupted wall layer, whereas CH-EUS findings include hypovascular enhancement and inhomogeneous contrast distribution pattern. In addition, FB-EUS and CH-EUS are useful for evaluating the stage of gallbladder carcinoma because they allow the evaluation of the depth of invasion of the gallbladder wall. It is usually difficult to obtain pathological evidence from gallbladder tumors before surgery and chemotherapy, even though the histological diagnosis is necessary for determining treatment policy. EUS-guided fine needle aspiration (EUS-FNA) is useful for obtaining pathological samples from gallbladder tumors before surgery and chemotherapy. The accuracy rate of EUS-FNA for gallbladder tumor is as high as 90%, but complications such as bile leakage and needle track seeding can be a problem, although it was reported that contrast-enhanced harmonic imaging is useful for avoiding them.
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Cassese G, Han HS, Yoon YS, Lee JS, Cho JY, Lee HW, Lee B, Troisi RI. Preoperative Assessment and Perioperative Management of Resectable Gallbladder Cancer in the Era of Precision Medicine and Novel Technologies: State of the Art and Future Perspectives. Diagnostics (Basel) 2022; 12:1630. [PMID: 35885535 PMCID: PMC9320561 DOI: 10.3390/diagnostics12071630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/07/2022] Open
Abstract
Gallbladder carcinoma (GBC) is a rare malignancy, with an estimated 5-year survival rate of less than 5% in the case of advanced disease. Surgery is the only radical treatment for early stages, but its application and effectiveness depend on the depth of tumoral invasion. The extent of resection is usually determined according to the T-stage. Therefore, an early and correct preoperative assessment is important for the prognosis, as well as for the selection of the most appropriate surgical procedure, to avoid unnecessary morbid surgeries and to reach the best outcomes. Several modalities can be used to investigate the depth of invasion, from ultrasounds to CT scans and MRI, but an ideal method still does not exist. Thus, different protocols are proposed according to different recommendations and institutions. In this scenario, the indications for laparoscopic and robotic surgery are still debated, as well as the role of new technologies such as next-generation sequencing and liquid biopsies. The aim of this article is to summarize the state of the art current modalities and future perspectives for assessing the depth of invasion in GBC and to clarify their role in perioperative management accordingly.
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Affiliation(s)
- Gianluca Cassese
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Jun Suh Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Hae-Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Boram Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Roberto Ivan Troisi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, 80131 Naples, Italy
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Okumura K, Gogna S, Gachabayov M, Felsenreich DM, McGuirk M, Rojas A, Quintero L, Seshadri R, Gu K, Dong XD. Gallbladder cancer: Historical treatment and new management options. World J Gastrointest Oncol 2021; 13:1317-1335. [PMID: 34721769 PMCID: PMC8529935 DOI: 10.4251/wjgo.v13.i10.1317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/19/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is a rare, aggressive malignancy that has a poor overall prognosis. Effective treatment consists of early detection and surgical treatment. With the wide spread treatment of gallbladder disease with minimally invasive techniques, the rate of incidental gallbladder cancer has seen an equitable rise along with stage migration towards earlier disease. Although the treatment remains mostly surgical, newer modalities such as regional therapy as well as directed therapy based on molecular medicine has led to improved outcomes in patients with advanced disease. We aim to summarize the management of gallbladder cancer along with the newer developments in this formidable disease process.
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Shekhar Gogna
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | | | - Matthew McGuirk
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Aram Rojas
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Luis Quintero
- Department of Surgery, New York Medical College, Valhalla, NY 10595, United States
| | - Ramanathan Seshadri
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
| | - Katie Gu
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
| | - Xiang Da Dong
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
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11
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Hijioka S, Nagashio Y, Ohba A, Maruki Y, Okusaka T. The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions. Diagnostics (Basel) 2021; 11:1586. [PMID: 34573929 PMCID: PMC8467412 DOI: 10.3390/diagnostics11091586] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has greater spatial resolution than other diagnostic imaging modalities. In addition, if gallbladder lesions are found and gallbladder cancer is suspected, EUS is an indispensable modality, enabling detailed tests for invasion depth evaluation using the Doppler mode and ultrasound agents. Furthermore, for gallbladder lesions, EUS fine-needle aspiration (EUS-FNA) can be used to differentiate benign and malignant forms of conditions, such as xanthogranulomatous cholecystitis, and collect evidence before chemotherapy. EUS-FNA is also useful for highly precise and specific diagnoses. However, the prevention of bile leakage, an accidental symptom, is highly important. Advancements in next-generation sequencing (NGS) technologies facilitate the application of multiple parallel sequencing to EUS-FNA samples. Several biomarkers are expected to stratify treatment for gallbladder cancer; however, NGS can unveil potential predictive genomic biomarkers for the treatment response. It is believed that NGS may be feasible with samples obtained using EUS-FNA, further increasing the demand for EUS-FNA.
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Affiliation(s)
- Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (Y.N.); (A.O.); (Y.M.); (T.O.)
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12
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Toyonaga H, Hayashi T, Ueki H, Chikugo K, Ishii T, Nasuno H, Kin T, Takahashi K, Takada M, Ambo Y, Shinohara T, Yamazaki H, Katanuma A. An intact boundary between the tumor and inner hypoechoic layer discriminates T1 lesions among sessile elevated gallbladder cancers. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:1121-1129. [PMID: 33826798 DOI: 10.1002/jhbp.961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/06/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The depth of invasion determines the surgical method for treating gallbladder cancer (GBC). However, the preoperative correct diagnosis of invasion depth, especially discrimination of T1 lesions among sessile elevated GBCs, is difficult. We investigated the utility of preoperative endoscopic ultrasound (EUS) findings for diagnosing the invasion depth. METHODS We studied a sessile elevated GBC specimen diagnosed as a T1 lesion before developing our study protocol. EUS evidenced an intact boundary between the tumor and the inner hypoechoic layer (the intact boundary sign). To evaluate the potential of using this sign to diagnose T1 GBC as a primary outcome indicator, we retrospectively analyzed patients who underwent surgical resection of sessile elevated GBCs between April 2009 and March 2020. RESULTS Of the 26 surgically resected sessile elevated GBC specimens, 20 were included and six were excluded due to difficulty in evaluating the overall tumor or layer structure. The Kappa coefficient for interobserver agreement regarding the intact boundary sign was 0.733. The sensitivity and specificity of the sign for diagnosing T1 lesions were 0.857 and 1.000, respectively. CONCLUSION This new EUS finding could guide the accurate diagnosis of T1 lesions in patients with sessile elevated GBC.
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Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hidetaro Ueki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kouki Chikugo
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hiroshi Nasuno
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Hajime Yamazaki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
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13
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Sugimoto M, Irie H, Takasumi M, Hashimoto M, Oka Y, Takagi T, Suzuki R, Konno N, Asama H, Sato Y, Nakamura J, Kato T, Kobashi R, Hashimoto Y, Marubashi S, Hikichi T, Ohira H. A simple method for diagnosing gallbladder malignant tumors with subserosa invasion by endoscopic ultrasonography. BMC Cancer 2021; 21:288. [PMID: 33731052 PMCID: PMC7972348 DOI: 10.1186/s12885-021-08017-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/09/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND If the depth of gallbladder malignant tumor (GBMT) invasion is deeper than the subserosa (ss), cholecystectomy is insufficient. In past reports that used endoscopic ultrasonography (EUS) to diagnose the depth of tumor invasion, it was difficult to diagnose GMBT invasion in the ss without a narrow or disrupted lateral hyperechoic layer (LHEL). Therefore, we developed a simple preoperative method to diagnose GBMTs with ss invasion. METHODS Forty-nine GBMT patients who underwent both EUS and surgery were enrolled: 15 patients whose tumors invaded the mucosa (m) or muscularis propria (mp) were classified as the "shallow group", and 34 patients whose tumors invaded the ss were classified as the "deep group". The EUS findings were compared between the two groups. RESULTS An irregular (narrow or thickened) LHEL was significantly more frequently observed on EUS in the deep group than in the shallow group. The diagnosis of ss invasion based on an irregular LHEL had the highest sensitivity and accuracy among the EUS imaging parameters (sensitivity 97.1% (33/34), specificity 86.7% (13/15), accuracy 93.8% (46/49)). When the deep group was limited to patients with a tumor depth of ss, the results were similar. When an irregular LHEL was used, the diagnostic accuracy of GBMTs with ss invasion was not significantly different between EUS specialists and beginners. CONCLUSIONS The observation of an irregular (thickened or narrow) LHEL observed on EUS could be a reliable and simple method of diagnosing GBMTs with ss invasion and could contribute to choosing an appropriate surgical method.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Minami Hashimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuka Oka
- Department of Diagnostic Pathology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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14
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Makar M, Zhao E, Tyberg A. Personalized Approach to the Role of Endoscopic Ultrasound in the Diagnosis and Management of Pancreaticobiliary Malignancies. J Pers Med 2021; 11:180. [PMID: 33806458 PMCID: PMC7999426 DOI: 10.3390/jpm11030180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/21/2022] Open
Abstract
Pancreaticobiliary malignancies arise from different areas within the pancreas and biliary tree. Endoscopic ultrasound (EUS) is a well-recognized diagnostic and therapeutic modality in the treatment of pancreaticobiliary diseases, and more specifically, pancreaticobiliary malignancies. Traditionally used for diagnostic purposes, EUS plays a critical role in tissue sampling and cancer staging. The emergence of the new field of interventional EUS has allowed EUS to also play a critical role in therapeutic management. Novel interventional EUS procedures such as EUS-guided gastrojejunostomy (EUS-GE), EUS-guided biliary drainage (EUS-BD), and EUS-guided gallbladder drainage (EUS-GLB) can be utilized to treat complications of pancreaticobiliary malignancies such as gastric outlet obstruction, obstructive jaundice, and cholecystitis. In addition, interventional EUS procedures can be utilized for the palliation of unresectable malignancies both for source control with EUS-radiofrequency ablation (EUS-RFA) and for the treatment of abdominal pain refractory to opioid medications with EUS-guided celiac axis neurolysis. However, patient selection remains a critical component in both diagnostic and therapeutic interventions and must be tailored to individual patient wishes, disease pathology, and overall prognosis.
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Affiliation(s)
- Michael Makar
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (M.M.); (E.Z.)
| | - Eric Zhao
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA; (M.M.); (E.Z.)
| | - Amy Tyberg
- Division of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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15
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Furuhashi T, Abe T, Sakata K, Noda M, Fuchikami T, Ishikawa N, Fujito H, Onari N, Hamada T. Extremely rare case of H-type gallbladder duplication coexistent with carcinoma: a case report and review of the literature. Surg Case Rep 2020; 6:193. [PMID: 32748059 PMCID: PMC7399013 DOI: 10.1186/s40792-020-00953-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Multiple gallbladders represent a rare congenital disorder, and coexistence with carcinoma is extremely rare, leading to a high possibility of misdiagnosis and surgical complications. In this study, a case was reported and the literature was reviewed. Case presentation An 80-year-old woman was diagnosed with acute cholecystitis via ultrasonography and was successfully treated with antibiotics. After the patient’s biliary colic relapsed, she was referred to our hospital. Multiple imaging modalities revealed duplication of her gallbladder (H-type) and suggested coexistence with carcinoma. According to preoperative evaluations, we assumed the patient had stage IIIA disease, and cholecystectomy, cholangiography using a near-infrared ray vision system, and sectionectomy of segments 4a and 5 were performed. Contrary to the high standardized uptake values obtained by 18F-fluoro-2-deoxy-D-glucose positron emission tomography, gallbladder carcinoma was pathologically diagnosed as stage 0 mucosal cancer. Seven days after the operation, portal thrombosis of the posterior branch was revealed, and conservative therapy was indicated; satisfactory results were achieved. The patient was discharged 65 days after surgery. No recurrence was observed for 1 year after surgery. Conclusions An extremely rare case of malignancy in a duplicated gallbladder was reported, and the literature was reviewed. Accurate estimations are feasible for diagnoses of multiple gallbladders, where correct evaluations are vital, especially in malignant cases. Because of the possibility of malignancy, resected accessory gallbladders should be scrutinized pathologically.
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Affiliation(s)
- Takashi Furuhashi
- Department of Surgery, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan.
| | - Toshihiko Abe
- Department of Surgery, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Koichiro Sakata
- Department of Surgery, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Mayaka Noda
- Department of Gastroenterology, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Tadafumi Fuchikami
- Department of Gastroenterology, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Nobuhisa Ishikawa
- Department of Gastroenterology, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Hiroyuki Fujito
- Department of Gastroenterology, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Norihiro Onari
- Department of Radiology, Japan Seafarers Relief Association Moji Ekisaikai Hospital, 1-3-1 Kiyotaki, Mojiku, Kitakyushu, 801-8550, Japan
| | - Tetsuo Hamada
- Department of Laboratory Medicine & Surgical pathology, Kyushu Railway Memorial Hospital, 2-1-1 Takada, Kitakyushu, 800-0031, Japan
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16
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Cross-sectional Imaging of Gallbladder Carcinoma: An Update. J Clin Exp Hepatol 2019; 9:334-344. [PMID: 31360026 PMCID: PMC6637089 DOI: 10.1016/j.jceh.2018.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 04/20/2018] [Indexed: 02/06/2023] Open
Abstract
Gallbladder Carcinoma (GBCA) is the most common biliary tract malignancy. As the disease is often diagnosed clinically in an advanced stage, the survival rates are dismal. Imaging studies allow for an early diagnosis of malignancy, though the findings may be indistinguishable from non-malignant disease processes affecting the gallbladder. Attempts have been made to make a specific diagnosis of GBCA at an early stage on imaging studies. Ultrasonography (US) is the most commonly employed technique for gallbladder evaluation. Gallbladder wall thickening is the most common finding of early GBCA and in this context, US is non-specific. Recently, contrast enhanced ultrasound has been shown to be effective in differentiating benign from malignant disease. Multidetector computed tomography represents the most robust imaging technique in evaluation of GBCA. It provides relatively sensitive evaluation of mural thickening, though it is not entirely specific and issues in differentiating GBCA from xanthogranulomatous cholecystitis do arise. Due to its superior soft tissue resolution, Magnetic Resonance Imaging (MRI) provides excellent delineation of gallbladder and biliary tree involvement. When coupled with functional MRI techniques, such as diffusion-weighted and perfusion imaging, it provides a useful problem solving tool for interrogating the malignant potential of nonspecific gallbladder lesions and detection of metastases. Positron emission tomography has a role in detection of distant metastases and following patients following treatment for malignancy. We review the current role of various imaging modalities in evaluating patients with GBCA.
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17
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A case report: Feasibility of a near infrared ray vision system (Photo dynamic eye®) for the postoperative ischemic complication of gallbladder carcinoma. Int J Surg Case Rep 2018; 53:312-315. [PMID: 30466038 PMCID: PMC6251061 DOI: 10.1016/j.ijscr.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/07/2018] [Indexed: 01/29/2023] Open
Abstract
Radical resection with or without preserving extra-hepatic bile duct has shown similar prognoses for gallbladder carcinoma. In the case of ischemic biliary complications of gallbladder carcinoma, whether to preserve the extrahepatic bile duct is a critical issue. Authentic indocyanine green near-infrared imaging is feasible for the estimation of the correct blood flow in postoperative ischemic biliary complications. Introduction Radical resection with or without preserving extra-hepatic bile duct has shown similar prognoses for gallbladder carcinoma (GB ca), although aggressive resection is essential. In preserving bile duct, ischemic complications are serious, life-threatening serious problems. Correct evaluation of the blood flow to the biliary tract is crucial. Case presentation A case of gallbladder ca in a 62-year-old man was reported. The patient was diagnosed with stage Ⅱ GB ca (T2, N0, M0) by ultrasonography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography. Cholecystectomy and intraoperative frozen section examination were planned. After recognition of invasion to subserosa and negative cystic duct margin, radical dissection of the lymph nodes in the hepatoduodenal ligament with preserving biliary tract was performed. Three days after the operation, biliary peritonitis was revealed. Emergency laparotomy showed ischemic bile leakage. Proper blood flow of the biliary system was realized by a near-infrared ray vision system (Photo Dynamic Eye®: HAMAMATSU Photonics) using indocyanine green. Primary suture of the extra-hepatic biliary duct and T-tube drainage were selected. No stricture of the bile system nor recurrence was recognized for two years after surgery. Discussion In the case of ischemic biliary complications, whether to preserve the extrahepatic bile duct is a critical issue for the surgeons. In this case study, the feasibility of authentic indocyanine green near-infrared imaging was shown for postoperative ischemic biliary situations. Conclusions Authentic indocyanine green near-infrared imaging was feasible for the estimation of the blood flow to the postoperative ischemic biliary complication.
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Affiliation(s)
- Teviah E Sachs
- Department of Surgery, Boston University School of Medicine, 88 East Newton Street, Collamore - C500, Boston, MA 02118, USA.
| | - Oluseyi Akintorin
- Department of Surgery, Harvard University School of Medicine, Beth Israel Deaconess Medical Center, Lowry Medical Office Building, 110 Francis Street, Suite 9B, Boston, MA 02215, USA
| | - Jennifer Tseng
- Department of Surgery, Boston University School of Medicine, 88 East Newton Street, Collamore - C500, Boston, MA 02118, USA
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19
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Sandrasegaran K, Menias CO. Imaging and Screening of Cancer of the Gallbladder and Bile Ducts. Radiol Clin North Am 2017; 55:1211-1222. [DOI: 10.1016/j.rcl.2017.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Goel M, Patkar S, Shinde R, Kurunkar S, Niyogi D, Shetty N, Ramadwar M. Radiological diagnosis alone risks overtreatment of benign disease in suspected gallbladder cancer: A word of caution in an era of radical surgery. Indian J Cancer 2017; 54:681-684. [DOI: 10.4103/ijc.ijc_516_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Chantarojanasiri T, Hirooka Y, Kawashima H, Ohno E, Kongkam P, Goto H. The role of endoscopic ultrasound in the diagnosis of gallbladder diseases. J Med Ultrason (2001) 2017; 44:63-70. [PMID: 27619811 DOI: 10.1007/s10396-016-0742-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022]
Abstract
Endoscopic ultrasound (EUS) has recently played an increasing role in the diagnosis of gallbladder diseases. This review aims to summarize the role of EUS in the diagnosis of gallbladder lesions. EUS provides high-resolution images that can improve the diagnosis of gallbladder polypoid lesions and microlithiasis, in addition to evaluating gallbladder thickness and staging of gallbladder carcinoma. Contrast-enhancing agents may be useful for the differential diagnosis of gallbladder lesions, but the evidence of their effectiveness is still limited and further studies are required in this area to establish its usefulness. Endoscopic ultrasound combined with fine needle aspiration has played an increasing role in providing histological diagnosis of gallbladder tumors in addition to gallbladder thickening.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Pradermchai Kongkam
- Department of Medicine, Gastrointestinal Endoscopy Excellent Center, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Hidemi Goto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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22
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Diagnostic accuracy of transabdominal high-resolution US for staging gallbladder cancer and differential diagnosis of neoplastic polyps compared with EUS. Eur Radiol 2016; 27:3097-3103. [PMID: 27832311 DOI: 10.1007/s00330-016-4646-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/29/2016] [Accepted: 10/12/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of transabdominal high-resolution ultrasound (HRUS) for staging gallbladder cancer and differential diagnosis of neoplastic polyps compared with endoscopic ultrasound (EUS) and pathology. MATERIALS AND METHODS Among 125 patients who underwent both HRUS and EUS, we included 29 pathologically proven cancers (T1 = 7, T2 = 19, T3 = 3) including 15 polypoid cancers and 50 surgically proven polyps (neoplastic = 30, non-neoplastic = 20). We reviewed formal reports and assessed the accuracy of HRUS and EUS for diagnosing cancer as well as the differential diagnosis of neoplastic polyps. Statistical analyses were performed using chi-square tests. RESULTS The sensitivity, specificity, PPV, and NPV for gallbladder cancer were 82.7 %, 44.4 %, 82.7 %, and 44 % using HRUS and 86.2 %, 22.2 %, 78.1 %, and 33.3 % using EUS. HRUS and EUS correctly diagnosed the stage in 13 and 12 patients. The sensitivity, specificity, PPV, and NPV for neoplastic polyps were 80 %, 80 %, 86 %, and 73 % using HRUS and 73 %, 85 %, 88 %, and 69 % using EUS. Single polyps (8/20 vs. 21/30), larger (1.0 ± 0.28 cm vs. 1.9 ± 0.85 cm) polyps, and older age (52.5 ± 13.2 vs. 66.1 ± 10.3 years) were common in neoplastic polyps (p < 0.05). CONCLUSION Transabdominal HRUS showed comparable accuracy for diagnosing gallbladder cancer and differentiating neoplastic polyps compared with EUS. HRUS is also easy to use during our routine ultrasound examinations. KEY POINTS • HRUS showed comparable diagnostic accuracy for GB cancer compared with EUS. • HRUS and EUS showed similar diagnostic accuracy for differentiating neoplastic polyps. • Single, larger polyps and older age were common in neoplastic polyps. • HRUS is less invasive compared with EUS.
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A Case of Cavernous Hemangioma of the Gallbladder Treated With Single-Incision Laparoscopic Cholecystectomy. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00015.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although hepatic hemangiomas are common, gallbladder (GB) hemangiomas are extremely rare. We present a case of a cavernous GB hemangioma, which was detected during routine ultrasonography screening. The 51-year-old female patient was asymptomatic and had no relevant medical history. The preoperative imaging findings, including those of endoscopic ultrasonography, suggested that malignancy was highly unlikely in this submucosal tumor. Thus, we performed a single-incision laparoscopic cholecystectomy as a diagnostic and curative procedure. The postoperative pathological examination confirmed a GB hemangioma. In this case, the preoperative diagnosis was quite difficult, especially because of this rare presentation of a GB hemangioma. This is probably why the definitive diagnosis is established postoperatively in most previously reported cases of GB hemangioma.
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Graff AE, Lewis SL, Bear JR, Van Echo DC, Dainer HM. Gallbladder Carcinoma, the Difficulty of Early Detection: A Case Report. Cureus 2016; 8:e493. [PMID: 27014527 PMCID: PMC4792642 DOI: 10.7759/cureus.493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gallbladder carcinoma (GBC) is an uncommon malignancy with a high mortality rate. Detecting gallbladder carcinoma in its early stages can be difficult, despite improvements in ultrasound and computed tomography (CT) imaging. Most diagnoses of GBC are made at advanced stages, with the majority being found incidentally during surgery for cholelithiasis. The presented case demonstrates the difficulty of diagnosing GBC preoperatively in its early stages.
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Affiliation(s)
- Andrew E Graff
- Radiation Oncology, Walter Reed National Military Medical Center
| | - Stephen L Lewis
- Radiation Oncology, Walter Reed National Military Medical Center
| | - Jonathan R Bear
- Radiation Oncology, Walter Reed National Military Medical Center
| | - David C Van Echo
- Hematology/Oncology, Walter Reed National Military Medical Center
| | - Hugh M Dainer
- Diagnostic Radiology, Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
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Determining the extent of cholecystectomy using intraoperative specimen ultrasonography in patients with suspected early gallbladder cancer. Surg Endosc 2015; 30:4229-38. [DOI: 10.1007/s00464-015-4733-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/15/2015] [Indexed: 01/21/2023]
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Ieni A, Barresi V, Todaro P, Caruso RA, Tuccari G. Cell-block procedure in endoscopic ultrasound-guided-fine-needle-aspiration of gastrointestinal solid neoplastic lesions. World J Gastrointest Endosc 2015; 7:1014-1022. [PMID: 26322154 PMCID: PMC4549658 DOI: 10.4253/wjge.v7.i11.1014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 02/05/2023] Open
Abstract
In the present review we have analyzed the clinical applications of endoscopic ultrasound-guided-fine-needle-aspiration (EUS-FNA) and the methodological aspects obtained by cell-block procedure (CBP) in the diagnostic approach to the gastrointestinal neoplastic pathology. CBP showed numerous advantages in comparison to the cytologic routine smears; in particular, better preservation of cell architecture, achievement of routine haematoxylin-eosin staining equivalent to histological slides and possibility to perform immunohistochemistry or molecular analyses represented the most evident reasons to choose this method. Moreover, by this approach, the differential diagnosis of solid gastrointestinal neoplasias may be more easily achieved and the background of contaminant non-neoplastic gastrointestinal avoided. Finally, biological samples collected by EUS-FNA CBP-assisted should be investigated in order to identify and quantify further potential molecular markers.
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High-resolution sonography for distinguishing neoplastic gallbladder polyps and staging gallbladder cancer. AJR Am J Roentgenol 2015; 204:W150-9. [PMID: 25615775 DOI: 10.2214/ajr.13.11992] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE. The purposes of this study were to compare staging accuracy of high-resolution sonography (HRUS) with combined low- and high-MHz transducers with that of conventional sonography for gallbladder cancer and to investigate the differences in the imaging findings of neoplastic and nonneoplastic gallbladder polyps. MATERIALS AND METHODS. Our study included 37 surgically proven gallbladder cancer (T1a = 7, T1b = 2, T2 = 22, T3 = 6), including 15 malignant neoplastic polyps and 73 surgically proven polyps (neoplastic = 31, nonneoplastic = 42) that underwent HRUS and conventional transabdominal sonography. Two radiologists assessed T-category and predefined polyp findings on HRUS and conventional transabdominal sonography. Statistical analyses were performed using chi-square and McNemar tests. RESULTS. The diagnostic accuracy for the T category was T1a = 92-95%, T1b = 89-95%, T2 = 78-86%, and T3 = 84-89%, all with good agreement (κ = 0.642) using HRUS. The diagnostic accuracy for differentiating T1 from T2 or greater than T2 was 92% and 89% on HRUS and 65% and 70% with conventional transabdominal sonography. Statistically common findings for neoplastic polyps included size greater than 1 cm, single lobular surface, vascular core, hypoechoic polyp, and hypoechoic foci (p < 0.05). The value of HRUS in the differential diagnosis of a gallbladder polyp was more clearly depicted internal echo foci than conventional transabdominal sonography (39 vs 21). A polyp size greater than 1 cm was independently associated with a neoplastic polyp (odds ratio = 7.5, p = 0.02). The AUC of a polyp size greater than 1 cm was 0.877. The sensitivity and specificity were 66.67% and 89.13%, respectively. CONCLUSION. HRUS is a simple method that enables accurate T categorization of gallbladder carcinoma. It provides high-resolution images of gallbladder polyps and may have a role in stratifying the risk for malignancy.
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Itano O, Oshima G, Minagawa T, Shinoda M, Kitago M, Abe Y, Hibi T, Yagi H, Ikoma N, Aiko S, Kawaida M, Masugi Y, Kameyama K, Sakamoto M, Kitagawa Y. Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma. Surg Endosc 2015; 29:3600-7. [PMID: 25740638 DOI: 10.1007/s00464-015-4116-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/05/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study evaluated our new strategy for treating suspected T2 gallbladder carcinoma (GBC) using a laparoscopic approach. METHODS We examined 19 patients with suspected T2 GBC who were treated laparoscopically (LS group) between December 2007 and December 2013; these patients were compared with 14 patients who underwent open surgery (OS group). Laparoscopic staging was initially performed to exclude factors making the patients ineligible for curative resection. Intraoperative pathological examination of the surgical margin of the cystic duct was performed prior to laparoscopic gallbladder bed resection, and pathological examination was again performed to confirm the presence of carcinoma and the depth of tumor invasion. Surgery was completed when the pathological findings indicated that the patient was cancer free. Lymph node dissection was performed according to the depth of tumor invasion. RESULTS None of the patients required conversion to laparotomy. For three patients with benign lesions, only gallbladder bed resection was required. Additional regional lymph node dissection was performed in 16 patients in the LS group. The mean operative time (309 vs. 324 min, p = 0.755) and mean number of dissected lymph nodes (12.6 vs. 10.2, p = 0.361) were not significantly different between the LS and OS groups. The intraoperative blood loss was significantly lower (104 vs. 584 mL, p = 0.002) and the postoperative hospital stay was significantly shorter (9.1 vs. 21.6 days, p = 0.002) for LS patients than for those in the OS group. In the LS group, one patient developed postoperative pneumonia, but all patients survived without recurrence after a mean follow-up of 37 months. CONCLUSION Our strategy for suspected T2 gallbladder GBC is safe and useful, avoids unnecessary procedures, and is associated with similar oncologic outcomes as the open method.
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Affiliation(s)
- Osamu Itano
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Go Oshima
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Takuya Minagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Shinoda
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Minoru Kitago
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Abe
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taizo Hibi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Yagi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naruhiko Ikoma
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Satoshi Aiko
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Miho Kawaida
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
| | - Yohei Masugi
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Michiie Sakamoto
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Kawasaki Y, Maemura K, Kurahara H, Mataki Y, Iino S, Sakoda M, Ueno S, Shinchi H, Takao S, Natsugoe S. Gallbladder adenocarcinoma with sarcoid-like reaction in regional lymph nodes: report of a case. BMC Cancer 2014; 14:946. [PMID: 25495692 PMCID: PMC4301567 DOI: 10.1186/1471-2407-14-946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/06/2014] [Indexed: 12/29/2022] Open
Abstract
Background Sarcoid-like reaction is often seen in various types of carcinoma, not only in the primary tumor, but also in regional lymph nodes, and can occur at any time, not only at the time of diagnosis, but also after treatment. However, few cases of hepatopancreatobiliary carcinoma, and no cases of gallbladder cancer with sarcoid-like reaction involving the lymph nodes have been described. This report is the first report of a sarcoid-like reaction involving the lymph nodes in a case of gallbladder cancer. Case presentation We encountered a rare case of gall bladder cancer with sarcoid-like reaction in the lymph nodes. Since regional lymph node swelling that was difficult to differentiate from metastasis was found preoperatively, swollen nodes were examined histologically using frozen sections. Based on this histology, the swollen nodes were diagnosed as showing sarcoid reaction and therefore extended lymphadenectomy was avoided. The patient did not receive any adjuvant chemotherapy and has shown no recurrence of disease as of 4 years after surgery. Conclusion Distinguishing between metastasis and sarcoid-like reaction in lymph nodes by preoperative imaging is still difficult. The present case shows that it is important to histologically examine swollen nodes by biopsy or by sampling before deciding on the treatment strategy for gall bladder cancer with swollen lymph nodes.
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Affiliation(s)
- Yota Kawasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan.
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Joo I, Lee JY, Baek JH, Kim JH, Park HS, Han JK, Choi BI. Preoperative differentiation between T1a and ≥T1b gallbladder cancer: combined interpretation of high-resolution ultrasound and multidetector-row computed tomography. Eur Radiol 2014; 24:1828-34. [PMID: 24838735 DOI: 10.1007/s00330-014-3206-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/23/2014] [Accepted: 04/28/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine the diagnostic value of combined interpretation of high-resolution ultrasound (HRUS) and multidetector-row computed tomography (MDCT) for preoperative differentiation between T1a and ≥T1b gallbladder (GB) cancer. METHODS Eighty-seven patients with pathologically confirmed GB cancers (T1a, n = 15; ≥T1b, n = 72), who preoperatively underwent both HRUS and MDCT, were included in this retrospective study. Two reviewers independently determined the T-stages of the GB cancers on HRUS and MDCT using a five-point confidence scale (5, definitely T1a; 1, definitely ≥T1b). For individual modality interpretation, the lesions with scores ≥4 were classified as T1a, and, for combined modality interpretation, the lesions with all scores ≥4 in both modalities were classified as T1a. The McNemar test was used to compare diagnostic performance. RESULTS The diagnostic accuracy of differentiation between T1a and ≥T1b GB cancer was higher using combined interpretation (90.8% and 88.5% for reviewers 1 and 2, respectively) than individual interpretation of HRUS (82.8% and 83.9%) or MDCT (74.7% and 82.8%) (P < 0.05, reviewer 1). Combined interpretations demonstrated 100% specificity for both reviewers, which was significantly higher than individual interpretations (P < 0.05, both reviewers). CONCLUSIONS Combined HRUS and MDCT interpretation may improve the diagnostic accuracy and specificity for differentiating between T1a and ≥T1b GB cancers. KEY POINTS • Differentiating between T1a and ≥T1b gallbladder cancer can help surgical planning. • HRUS and MDCT are useful for local staging of gallbladder cancer. • HRUS and MDCT may be synergistic for T-staging of gallbladder cancer.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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Kim SJ, Lee JM, Lee ES, Han JK, Choi BI. Preoperative staging of gallbladder carcinoma using biliary MR imaging. J Magn Reson Imaging 2014; 41:314-21. [PMID: 24470425 DOI: 10.1002/jmri.24537] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/14/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the performance of biliary MRI, including unenhanced imaging, gadolinium-enhanced (Gd-E) dynamic imaging, and MR cholangiography, for the preoperative staging of gallbladder cancer (GBC). MATERIALS AND METHODS Our institutional review board approved this retrospective study. Eighty-six, consecutive patients with surgically resected and pathologically confirmed GBCs and who underwent preoperative MRI, including unenhanced T1- and T2-weighted images, MR cholangiography, and dynamic imaging, were enrolled in this study. Two observers independently evaluated the biliary MR images regarding the T- and N-staging of GBCs and graded their diagnostic confidence for the staging using a 5-point scale. Receiver operating curve analysis was performed to evaluate the diagnostic performance of MR in the staging of GBC. Interobserver agreement was evaluated using kappa statistics. RESULTS The overall accuracy of T- and N-staging using biliary MRI was 84.9% and 77.9% for observer 1 and 69.8% and 74.4% for observer 2. There was good interobserver agreement regarding the T stage (k = 0.828). The Az (AUC: area under the curve) values of the diagnostic ability of MRI to differentiate ≥ T1b from ≤ T1a lesions, were 0.979 and 0.955 for both observers (P < 0.0001). CONCLUSION Biliary MRI with MR cholangiography allows moderately accurate preoperative T staging and N staging of GBCs. It also shows an excellent diagnostic ability for differentiating ≥ T1b lesions from ≤ T1a lesions, which can be helpful for preoperative planning.
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Affiliation(s)
- Soo Jin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea; Department of Radiology, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
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Agarwal AK, Kalayarasan R, Javed A, Gupta N, Nag HH. The role of staging laparoscopy in primary gall bladder cancer--an analysis of 409 patients: a prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer. Ann Surg 2013; 258:318-323. [PMID: 23059504 DOI: 10.1097/sla.0b013e318271497e] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the role of staging laparoscopy (SL) in the management of gallbladder cancer (GBC). METHODS A prospective study of primary GBC patients between May 2006 and December 2011. The SL was performed using an umbilical port with a 30-degree telescope. Early GBC included clinical stage T1/T2. A detectable lesion (DL) was defined as one that could be detected on SL alone, without doing any dissection or using laparoscopic ultrasound (surface liver metastasis and peritoneal deposits). Other metastatic and locally advanced unresectable disease qualified as undetectable lesions (UDL). RESULTS Of the 409 primary GBC patients who underwent SL, 95 had disseminated disease [(surface liver metastasis (n = 29) and peritoneal deposits (n = 66)]. The overall yield of SL was 23.2% (95/409). Of the 314 patients who underwent laparotomy, an additional 75 had unresectable disease due to surface liver metastasis (n = 5), deep parenchymal liver metastasis (n = 4), peritoneal deposits (n = 1), nonlocoregional lymph nodes (n = 47), and locally advanced unresectable disease (n = 18), that is, 6-DL and 69-UDL. The accuracy of SL for detecting unresectable disease and DL was 55.9% (95/170) and 94.1% (95/101), respectively. Compared with early GBC, the yield was significantly higher in locally advanced tumors (n = 353) [25.2% (89/353) vs 10.7% (6/56), P = 0.02]. However, the accuracy in detecting unresectable disease and a DL in locally advanced tumors was similar to early GBC [56.0%, (89/159) and 94.1%, (89/95) vs 54.6% (6/11) and 100% (6/6), P = 1.00]. CONCLUSIONS In the present series with an overall resectability rate of 58.4%, SL identified 94.1% of the DLs and thereby obviated a nontherapeutic laparotomy in 55.9% of patients with unresectable disease and 23.2% of overall GBC patients. It had a higher yield in locally advanced tumors than in early-stage tumors; however, the accuracy in detecting unresectable disease and a DL were similar.
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Affiliation(s)
- Anil K Agarwal
- Department of Gastrointestinal Surgery and Liver Transplant, Govind Ballabh Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India.
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Jin W, Zhang C, He X, Xu Y, Wang L, Zhao Z. Differences between images of large adenoma and protruding type of gallbladder carcinoma. Oncol Lett 2013; 5:1629-1632. [PMID: 23760294 PMCID: PMC3678592 DOI: 10.3892/ol.2013.1248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/18/2013] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate the differences between images of large adenoma of the gallbladder and the protruding type carcinoma of the gallbladder. A retrospective study was performed on 130 patients who underwent cholecystectomy or biopsy for gallbladder polypoid lesions larger than 10 mm; among them, 20 patients were malignant and 110 patients were benign. Patients’ details including ultrasonography (US), computed tomography (CT) and magnetic resonance (MR) findings were analyzed. All patients whose lesions were >15 mm by US, had CT or MR scans to further determine the nature of the lesion; two patients who were suspected to have a malignant lesion due to their large tumor size were benign by histological examination. Distinct differences were found between large adenoma and protruding type of gallbladder carcinoma. There were distinct differences between adenomas and the protruding type gallbladder cancers, and there was a pathological basis for the differences. Benign tumors had a more homogeneous texture, had spaces between the tumor and the gallbladder wall and a relatively normal configuration of the gallbladder wall. Based on these findings, certain lesions could be definitively diagnosed as benign adenomas and could help in treatment strategy.
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Affiliation(s)
- Wangxun Jin
- Departments of Hepatology and Biliary Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, P.R China ; Department of Abdominal Tumor Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, P.R China
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Anderson MA, Appalaneni V, Ben-Menachem T, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fisher LR, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan K, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc 2013; 77:167-74. [PMID: 23219047 DOI: 10.1016/j.gie.2012.09.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 02/08/2023]
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Song HL, Shin JH, Kim H, Park YL, Yoo CH, Son BH, Yoon JS, Kim HO. Clinical and radiologic preoperative predicting factors for GB cholesterol polyp. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:232-7. [PMID: 22493764 PMCID: PMC3319777 DOI: 10.4174/jkss.2012.82.4.232] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/22/2012] [Accepted: 02/02/2012] [Indexed: 01/08/2023]
Abstract
PURPOSE To use the clinical and radiological data to differentiate non-cholesterol versus cholesterol gall bladder (GB) polyps, which can be useful in deciding the treatment of the patient. METHODS One hundred and eighty-seven patients underwent cholecystectomy for GB polyps of around 10 mm for 10 years, and were divided into two groups, cholesterol polyps (146 patients) and non-cholesterol polyps (41 patients) based on the postoperative pathological findings. Gender, age, body weight, height, body mass index (BMI), symptoms, laboratory findings, size, number of polyps, presence of GB stone and maximum diameter measured by preoperative ultrasonography (USG), computed tomography (CT), and pathological diameter were subjected to comparative analysis. RESULTS Patients diagnosed with cholesterol polyps were younger in age and had higher BMI, and the total cholesterol levels and white blood cell levels were higher, but were not statistically significant. It was notable to see that 28.6% of the cholesterol polyps were not found in the preoperative CT yet the percentage of the undetectable rate was significantly lower (8%) in the non-cholesterol polyp group. There was a discrepancy in maximum diameters between the two radiological methods in both groups but the discrepancy was significantly larger in the cholesterol polyp group. CONCLUSION The clinical signs that can be helpful to diagnose whether it is a cholesterol polyp or not are younger patients who have high BMI, polyps which are detectable only on the USG and large maximum diameters between the USG and CT. And if the discrepancy of the maximum diameter is lesser than 1mm the polyp may be considered as a non-cholesterol polyp.
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Affiliation(s)
- Hye-Lin Song
- Department of Surgery, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI, Choi SH. Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening. Dig Dis Sci 2012; 57:508-515. [PMID: 21879282 DOI: 10.1007/s10620-011-1870-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/12/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The differential diagnosis of gallbladder (GB) cancer from inflammatory diseases in patients with a thickened GB wall is difficult, whereas the pre-operative diagnosis of GB cancer is critical for selecting the appropriate surgical modality. We evaluated the clinical usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of GB wall thickening. METHODS The medical records, post-operative pathology reports, and images of EUS for 134 patients with GB wall thickening (>3 mm) who underwent laparoscopic or open cholecystectomies at our institution between December 2006 and February 2010 were retrospectively reviewed. RESULTS Thirteen patients (9.7%) had neoplastic GB wall thickening (11 with adenocarcinomas and two with adenosquamous carcinomas) and the remaining 121 patients (90.3%) had non-neoplastic GB wall thickening (117 with inflammatory GB wall thickening and four with adenomyomatosis). The mean (± standard deviation [SD], mm) GB wall thickness was 6.5 ± 3.3 and 19.4 ± 7.7 for non-neoplastic and neoplastic GB wall thickening, respectively (P < 0.01). The EUS variables which had a statistically significant association with neoplastic GB wall thickening were GB wall thickening >10 mm, disruption of the normal two layers of the GB wall, hypoechoic internal echogenecity, and the absence of gallstones. Based on the multivariate analyses, GB wall thickening >10 mm and hypoechoic internal echogenecity were independent predictive factors for neoplastic GB wall thickening. CONCLUSIONS The diagnostic power of EUS for differentiating neoplastic and non-neoplastic GB wall thickening could be improved by the appropriate application of some EUS variables.
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Affiliation(s)
- Hong Joo Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, South Korea.
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Gallbladder carcinoma incidentally encountered during laparoscopic cholecystectomy: how to deal with it. Clin Transl Oncol 2011; 13:25-33. [DOI: 10.1007/s12094-011-0613-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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O'Neill DER, Saunders MD. Endoscopic ultrasonography in diseases of the gallbladder. Gastroenterol Clin North Am 2010; 39:289-305, ix. [PMID: 20478487 DOI: 10.1016/j.gtc.2010.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In recent years, endoscopic ultrasonography (EUS) has emerged as an important tool for the diagnosis and management of pancreaticobiliary disease. The close proximity of the echoendoscope to the biliary system allows detailed imaging of the gallbladder and adjacent structures. EUS is useful for the detection of occult cholelithiasis and biliary sludge and in the evaluation of suspected choledocholithiasis. It can be used to classify and predict neoplasia in polypoid lesions of the gallbladder and also to diagnose and stage gallbladder carcinoma. This article reviews the use of EUS in these diseases of the gallbladder.
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Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg 2010; 250:943-9. [PMID: 19855259 DOI: 10.1097/sla.0b013e3181b5d5fc] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The authors undertook to investigate the diagnostic performance of high-resolution ultrasound (HRUS), and to compare the differential diagnostic and staging accuracies of endoscopic ultrasonography (EUS), HRUS, and multidetector computed tomography for gallbladder (GB) polypoid lesions and GB cancer. SUMMARY OF BACKGROUND DATA Endoscopic ultrasonography was considered the most sensitive diagnostic modality for GB polypoid lesions. However, recent technical advancements in other image modalities including conventional sonography (US) allow the production of comparable images. METHODS A total of 170 patients, with a more than 1-cm sized polypoid GB lesion, and without evidence of definite local invasion to adjacent organs during primary screening, were consecutively enrolled in this prospective, blind, comparative study. After excluding 26 patients with inappropriate medical histories, 144 patients were finally enrolled. All patients underwent surgical resection. Clinical diagnoses were compared with histopathologic findings by diagnostic modality. RESULTS Of the 144 patients, there were 115 (79.8%) cases of benign GB polypoid lesions and 29 (20.2%) cases of GB cancers. Diagnostic sensitivities for malignancy were 90% for HRUS, 86% for EUS, and 72% for CT. When evaluating the abilities of these modalities to predict GB cancer depth of invasion, we excluded 2 unusual GB malignancies (melanoma and lymphoma), HRUS was found to have the highest diagnostic accuracy of 62.9%; EUS and CT had accuracies of 55.5% and 44.4%, respectively. CONCLUSIONS The diagnostic accuracies of HRUS and EUS for the differential diagnosis of GB polypoid lesions were comparable. In view of patient comfort and no requirement for sedation, we consider that HRUS is likely to become an important diagnostic modality for the differential diagnosis and staging of GB polypoid lesions and early GB cancer.
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Wiedmann M, Witzigmann H, Mössner J. Malignant Tumors. CLINICAL HEPATOLOGY 2010:1519-1566. [DOI: 10.1007/978-3-642-04519-6_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Mishra G, Conway JD. Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree. Curr Gastroenterol Rep 2009; 11:150-4. [PMID: 19281703 DOI: 10.1007/s11894-009-0023-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastroenterologists increasingly find themselves in the un-enviable position of having to choose the optimal radiographic test to visualize the biliary tree and the liver. This dilemma is compounded by the rapid evolution of the available technologies and their ever-increasing resolution capabilities. Endoscopic ultrasound (EUS) has shown itself to be equally capable of providing detailed imaging of the biliary tree and of surrounding structures; its potential for evaluating liver lesions is just now being realized. EUS-fine needle aspiration (FNA) may supplant some of the existing technologies as it offers a way to sample masses, strictures, lymph nodes, and now certain segments of the liver and periportal regions. This review takes an in-depth look at the role of EUS in evaluating bile duct dilatation, suspected choledocholithiasis, biliary strictures, and polyps and masses of the gallbladder. It also reviews the literature on the exciting and rapidly evolving role of EUS-FNA evaluation of occult, metastatic, and primary hepato-cellular malignancies, as well as periportal lesions. Technologies such as EUS elastography may completely obviate FNA of liver lesions.
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Affiliation(s)
- Girish Mishra
- Section on Gastroenterology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Vialle R, Velasco S, Milin S, Bricot V, Richer JP, Levillain PM, Tasu JP. [Imaging in the diagnosis and the staging of gallbladder tumors]. ACTA ACUST UNITED AC 2008; 32:931-41. [PMID: 18954953 DOI: 10.1016/j.gcb.2008.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 08/10/2008] [Accepted: 09/12/2008] [Indexed: 02/07/2023]
Abstract
Most of gallbladder tumors are benign. Adenoma, cholesterol polyps, or adenomyomatosis are most frequently typical on ultrasonographic images. All symptomatic lesions must be considered as indications for surgery. It may be difficult to identify precancerous or malignant lesion. Polyps over 1cm are indication for preventive cholecystectomy. In case of suspicious polyp or suspicious wall thickening, endoscopic ultrasonography can be helpful to evaluate local tumoral spread and eliminate differential diagnosis. Unfortunately, diagnosis of gallbladder cancer is often late, when surgical resection can't be curative. Computed tomography and magnetic resonance imaging examinations are then useful for local and metastatic staging.
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Affiliation(s)
- R Vialle
- Service de radiologie, CHU de Poitiers, BP 577, 86021 Poitiers, France.
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Diagnosis of biliary tract and ampullary carcinomas. ACTA ACUST UNITED AC 2008; 15:31-40. [PMID: 18274842 PMCID: PMC2794353 DOI: 10.1007/s00534-007-1278-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 10/22/2007] [Indexed: 12/16/2022]
Abstract
Diagnostic methods for biliary tract carcinoma and the efficacy of these methods are discussed. Neither definite methods for early diagnosis nor specific markers are available in this disease. When this disease is suspected on the basis of clinical symptoms and risk factors, hemato-biochemical examination and abdominal ultrasonography are performed and, where appropriate, enhanced computed tomography (CT) and/or magnetic resonance cholangiopancreatography (MRCP) is carried out. Diagnoses of extrahepatic bile duct cancer and ampullary carcinoma are often made based on the presence of obstructive jaundice. Although rare, abdominal pain and pyrexia, as well as abnormal findings of the hepatobiliary system detected by hemato-biochemical examination, serve as a clue to making a diagnosis of these diseases. On the other hand, the early diagnosis of gallbladder cancer is scarcely possible on the basis of clinical symptoms, so when this cancer is found with the onset of abdominal pain and jaundice, it is already advanced at the time of detection, thus making a cure difficult. When gallbladder cancer is suspected, enhanced CT is carried out. Multidetector computed tomography (MDCT), in particular — one of the methods of enhanced CT — is useful for decision of surgical criteria, because MDCT shows findings such as localization and extension of the tumor, and the presence or absence of remote metastasis. Procedures such as magnetic resonance imaging, endoscopic ultrasonography, bile duct biopsy, and cholangioscopy should be carried out taking into account indications for these procedures in individual patients. However, direct biliary tract imaging is necessary for making a precise diagnosis of the horizontal extension of bile duct cancer.
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Miller G, Schwartz LH, D'Angelica M. The use of imaging in the diagnosis and staging of hepatobiliary malignancies. Surg Oncol Clin N Am 2007; 16:343-68. [PMID: 17560517 DOI: 10.1016/j.soc.2007.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review addresses the optimal use of imaging in the diagnosis, staging, and treatment planning of patients with hepatobiliary neoplasms. We focus on primary liver cancers, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma as well as extrahepatic biliary tract malignancies, including hilar cholangiocarcinoma and gallbladder cancer. In each section, we provide an overview of the staging requirements for each disease followed by a discussion of various imaging modalities that can be used to optimally stage the disease and plan therapy.
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Affiliation(s)
- George Miller
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Rodríguez-Fernández A, Gómez-Río M, Medina-Benítez A, Moral JVD, Ramos-Font C, Ramia-Angel JM, Llamas-Elvira JM, Ferrón-Orihuela JA, Lardelli-Claret P. Application of modern imaging methods in diagnosis of gallbladder cancer. J Surg Oncol 2006; 93:650-64. [PMID: 16724342 DOI: 10.1002/jso.20533] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The poor prognosis of gallbladder cancer (GBC) is related to its dissemination capacity and usually late diagnosis due to its non-specific clinical appearance. Recent improvements in hepatobiliary surgery have underlined the importance of an early specific diagnosis, which requires a multidisciplinary approach and, when possible, specialized equipment. The first step in an early diagnosis is to identify patients in the appropriate epidemiological setting (e.g., incidental finding, chronic cholecystitis) for the correct interpretation of test results. It is desirable to enhance the sensitivity of the initial ultrasound (US) examination by use of the appropriate technology in skilled specialist hands. When GBC is suggested by US findings, FDG-PET can be considered complementary to establish the benign/malignant nature of the lesion and to obtain a primary staging study. If GBC is confirmed, thin slice spiral CT can contribute valuable information on local spread. In this regard, recent hybrid PET-CT systems provide structural and functional information simultaneously and may offer early and accurate T, N, and M staging with an improved specificity.
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Weickert U, Jakobs R, Riemann J. Stellenwert der endoskopischen retrograden Cholangiopankreatographie, der perkutan-transhepatischen Cholangiographie, der Endosonographie und der endoluminalen Sonographie in der Behandlung des Gallenblasen- und des Gallengangkarzinoms. Visc Med 2004. [DOI: 10.1159/000083011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE OF REVIEW Biliary tract neoplasm is one of the most aggressive malignancies, with a very poor prognosis. Most cancers of the biliary tract will have grown beyond the limits of curative resection by the time they become clinically evident. This reality has fostered therapeutic nihilism, and most physicians and surgeons, in their pessimism, have to run ambitious trials evaluating new diagnostic tools and therapeutic techniques in this disease. RECENT FINDINGS Advances in imaging over the period of the last 5 years now allow for earlier diagnosis and better surgical planning. Recent improvements in operative technique have substantially improved the outlook of patients with this cancer. Palliative management of obstructive disease recently has been improved with the advent of photodynamic therapy. Among the different drugs tested in this disease, gemcitabine seems to have the best efficacy:toxicity ratio. However, efficacy results remain disappointing, and combination schedules need to be developed to improve the results. Among them, the gemcitabine-oxaliplatin combination seems to be one of the most promising schedules. Biological studies, especially those evaluating mutation-independent activation of the Hedgehog pathway, have provided interesting information on the carcinogenesis of this rare tumor. Furthermore, these results bring us the opportunity of development of future targeted therapies in biliary tract cancer. SUMMARY Biliary tract neoplasm remains one of the most aggressive malignancies. However, as for other gastrointestinal malignancies, biological studies and diagnostic and therapeutic improvements have provided interesting results that could lead to a major improvement in the prognosis of this disease.
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Affiliation(s)
- David Malka
- Unité de Gastroentérologie, Institut Gustave Roussy, Villejuif, France
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