Gallbladder cancer: can ultrasonography evaluate extent of disease?

Abstract

This study reviews the spectrum of sonographic findings in patients with gallbladder cancer, attempts to determine if sonography can identify patients with potentially resectable disease, and emphasizes the limitations of ultrasonography in the evaluation of ‐gallbladder cancer. Thirty‐five consecutive patients with histologically proven gallbladder carcinoma who had preoperative abdominal ultrasonography and surgery were identified. Involvement of the gallbladder and gallbladder fossa, metastases, bile ducts, portal vein, and adjacent lymph nodes was assessed sonographically. The extent of disease and staging as revealed by sonography was compared to operative and surgical pathologic findings. Masses in the gallbladder or gallbladder fossa were present at surgery in 26 patients; 22 (85%) of these masses were shown by sonography. Sonography identified six (67%) of nine cases of pathologically confirmed liver metastases, 11 (79%) of 14 cases of bile duct involvement, and two (67%) of three cases of portal venous involvement by tumor. Sonography revealed lymph node metastases in only five (36%) of 14 patients. None of the 12 cases with peritoneal metastases was identified sonographically. By surgical staging 16 (46%) patients had potentially resectable disease (stage III or less), and 19 (54%) patients had unresectable stage IV disease. Sonography correctly identified 15 (94%) of 16 patients with potentially resectable disease and seven (37%) of 19 patients with advanced disease. Twelve patients with advanced disease were under‐staged: nine had peritoneal metastases, two had liver metastases, and one had celiac adenopathy, which was not shown by sonography. In conclusion, sonography is reliable in the detection of a primary gallbladder mass or of local extension of tumor into the liver. However, sonographic findings do not accurately reflect the full extent of disease, and sonography is particularly limited in the diagnoses of metastases to the peritoneum and lymph nodes.

Application of modern imaging methods in diagnosis of gallbladder cancer

“…Few studies have been published on the usefulness of US to determine tumor resectability [30,33,42,43]. Bach et al [30] compared US with intraoperative findings in 26 patients with GBC and found that US had an accuracy of 0.63 to determine the non-resectability of the tumor (Se: 0.94; Sp: 0.37; PPV: 0.56; NPV: 0.88).…”

“…Few studies have been published on the usefulness of US to determine tumor resectability [30,33,42,43]. Bach et al [30] compared US with intraoperative findings in 26 patients with GBC and found that US had an accuracy of 0.63 to determine the non-resectability of the tumor (Se: 0.94; Sp: 0.37; PPV: 0.56; NPV: 0.88). US was useful to detect the primary mass and its spread to the liver but did not completely reflect the extent of the disease, and was especially limited in the localization of metastases to peritoneum and lymph nodes [30].…”

“…Bach et al [30] compared US with intraoperative findings in 26 patients with GBC and found that US had an accuracy of 0.63 to determine the non-resectability of the tumor (Se: 0.94; Sp: 0.37; PPV: 0.56; NPV: 0.88). US was useful to detect the primary mass and its spread to the liver but did not completely reflect the extent of the disease, and was especially limited in the localization of metastases to peritoneum and lymph nodes [30]. In another prospective study to stage GBC in 26 patients (performed by a single ultrasonographist), Haribhakti et al [43] obtained even worse results, with global accuracy of only 0.38; most errors corresponded to understaging due to undetected local infiltration or metastatic dissemination [43].…”

“…Journal of Surgical Oncology DOI 10.1002/jso However, the detection of early lesions is much more problematic [23,[29][30][31][32][33][34]. An early carcinoma is defined as one that is confined to the mucosal layer, including Rokitansky-Aschoff sinuses, up to the muscularis propia.…”

Role of Ultrasound and Computed Tomography in the Evaluation of Gallbladder Malignancy

“…Thisis in close agreement with thestudy ofOhtaniet al 19 where hepatic parenchymal involvement was found in 65% patients. Bach et al 20 described that ultrasonography is reliablein the detection of primary gallbladder mass. However, sonographic findings do not accurately reflect the full extent ofdisease and sonography is particularly limited in the diagnosis ofinvasion to the liver, lymph nodes, peritoneum etc.…”