Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma

Table 1 Key imaging findings, diagnostic interpretation, and sources of overlap between xanthogranulomatous cholecystitis and gallbladder carcinoma

Imaging finding	Typical interpretation	Relative diagnostic value	Why it favors this diagnosis	Source of diagnostic overlap
Diffuse wall thickening	XGC	Moderate	Chronic transmural inflammation	May occur in infiltrative GBC
Continuous mucosal line	XGC	Higher	Relative preservation of mucosal integrity	Can be partially preserved in early GBC
Intramural hypoattenuating nodules	XGC	Higher	Xanthogranulomatous inflammation	Not universally present
Gallstones	XGC	Limited	Chronic obstruction and inflammation	Common in both diseases
Intraluminal mass	GBC	Moderate	Neoplastic tissue proliferation	Inflammatory pseudotumoral lesions may mimic mass formation
Lymphadenopathy	GBC	Moderate	Regional tumor spread	Reactive inflammatory nodes may occur in XGC
Biliary obstruction	GBC	Moderate	Ductal invasion or compression	Severe inflammatory disease may produce similar findings
Hepatic invasion	GBC	Higher	Direct local extension	Inflammatory infiltration may mimic true invasion
Vascular encasement	GBC	Higher	Advanced locoregional disease	Rare inflammatory pseudoinvasion

Relative diagnostic value is intended as a qualitative assessment based on the consistency and discriminatory relevance of each finding across the studies discussed in this review; it does not represent a formal grading of the level of evidence. XGC: Xanthogranulomatous cholecystitis; GBC: Gallbladder carcinoma.

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

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

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