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| {{CMG}}; {{AE}}{{VKG}} | | {{CMG}}; {{AE}}{{VKG}} |
| ==Overview== | | ==Overview== |
| According to the National Comprehensive Cancer Network (NCCN) guidelines, gallbladder cancer may be diagnosed as an accidental finding in patients who undergo [[laparoscopic]] [[cholecystectomy]]. | | According to the National Comprehensive Cancer Network (NCCN) guidelines, [[gallbladder cancer]] may be diagnosed as an incidental finding in patients who undergo [[laparoscopic]] [[cholecystectomy]]. |
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| ==Screening== | | ==Screening== |
| * According to the NCCN guidelines, [[screening]] for gallbladder cancer patients is recommended with [[Endoscopy|endoscopic]] ultrasongraphy (EUS), [[computed tomography]] (CT) , [[magnetic resonance imaging]] (MRI) with/without contrast and patients after incidental finding during [[laparoscopic]] [[cholecystectomy]] patient are recommmends considering staging [[laparoscopy]].<sup> </sup> | | * According to the NCCN guidelines, [[screening]] for [[gallbladder cancer]] patients include followings: |
| | | **[[Endoscopic ultrasound|Endoscopic]] ultrasonography (EUS) |
| == Ultrasound ==
| | **[[Computed tomography]] ([[Computed tomography|CT]]) |
| * When [[gallbladder]] pathology is suspected [[ultrasonography]] is most commonly the first choice for screening. | | **[[Magnetic resonance imaging]] ([[MRI]]) with/without contrast |
| | *Patients after incidental finding during [[laparoscopic]] [[cholecystectomy]] patient are recommends considering staging [[laparoscopy]].<sup> </sup> |
| | * When [[gallbladder]] pathology is suspected [[ultrasonography]] is most commonly the first choice for [[Screening (medicine)|screening]]. |
| * [[Sensitivity]] and [[specificity]] of [[ultrasound]] screening is 85% and 80%. | | * [[Sensitivity]] and [[specificity]] of [[ultrasound]] screening is 85% and 80%. |
| * A High-resolution contrast-enhanced ultrasonography identifies up to 70–90% of [[Polypoidy|polypoid]] gallbladder lesions.<ref name="pmid21628925">{{cite journal |vauthors=Inui K, Yoshino J, Miyoshi H |title=Diagnosis of gallbladder tumors |journal=Intern. Med. |volume=50 |issue=11 |pages=1133–6 |year=2011 |pmid=21628925 |doi= |url=}}</ref> | | * High-resolution contrast-enhanced [[ultrasonography]] identifies up to 70–90% of [[Polypoidy|polypoid]] [[gallbladder]] lesions.<ref name="pmid21628925">{{cite journal |vauthors=Inui K, Yoshino J, Miyoshi H |title=Diagnosis of gallbladder tumors |journal=Intern. Med. |volume=50 |issue=11 |pages=1133–6 |year=2011 |pmid=21628925 |doi= |url=}}</ref> |
| * Gallbladder cancer on ultrasound have one of the following feartures<ref name="pmid26421012">{{cite journal |vauthors=Kanthan R, Senger JL, Ahmed S, Kanthan SC |title=Gallbladder Cancer in the 21st Century |journal=J Oncol |volume=2015 |issue= |pages=967472 |year=2015 |pmid=26421012 |pmc=4569807 |doi=10.1155/2015/967472 |url=}}</ref>
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| ** 1) A mass in the gallbladder
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| ** 2) A [[polyp]] in the gallbladder
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| ** 3) Asymmetric wall thickening of the [[gallbladder]]
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| * [[Polyps]] which are over 1 cm in [[diameter]] have higher chance to contain an [[invasive]] cancer than smaller ones.<ref name="pmid7572497">{{cite journal |vauthors=Wibbenmeyer LA, Sharafuddin MJ, Wolverson MK, Heiberg EV, Wade TP, Shields JB |title=Sonographic diagnosis of unsuspected gallbladder cancer: imaging findings in comparison with benign gallbladder conditions |journal=AJR Am J Roentgenol |volume=165 |issue=5 |pages=1169–74 |year=1995 |pmid=7572497 |doi=10.2214/ajr.165.5.7572497 |url=}}</ref>
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| * With Contrast-enhanced ultrasonography gallbladder cancer shows an “eruption sign”<ref name="pmid24959553">{{cite journal |vauthors=Vijayakumar A, Vijayakumar A, Patil V, Mallikarjuna MN, Shivaswamy BS |title=Early diagnosis of gallbladder carcinoma: an algorithm approach |journal=ISRN Radiol |volume=2013 |issue= |pages=239424 |year=2013 |pmid=24959553 |pmc=4045520 |doi=10.5402/2013/239424 |url=}}</ref>
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| == Computer Tomography (CT) ==
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| * The most common [[Non-invasive (medical)|non-invasive]] imaging studies for evaluating [[gallbladder]] cancer include CT.
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| * In [[diagnosis]] and staging of GBC CT scan is useful.
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| * Ct scan is helpful in detection of invasion to adjacent tissues like liver, [[lymphadenopathy]] and other organs
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| * In CT scan features of [[gallbladder cancer]] include<ref name="pmid22581235">{{cite journal |vauthors=Deshmukh SD, Johnson PT, Sheth S, Hruban R, Fishman EK |title=CT of gallbladder cancer and its mimics: a pattern-based approach |journal=Abdom Imaging |volume=38 |issue=3 |pages=527–36 |year=2013 |pmid=22581235 |doi=10.1007/s00261-012-9907-1 |url=}}</ref><ref name="pmid249595533">{{cite journal |vauthors=Vijayakumar A, Vijayakumar A, Patil V, Mallikarjuna MN, Shivaswamy BS |title=Early diagnosis of gallbladder carcinoma: an algorithm approach |journal=ISRN Radiol |volume=2013 |issue= |pages=239424 |year=2013 |pmid=24959553 |pmc=4045520 |doi=10.5402/2013/239424 |url=}}</ref>
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| ** Polypoid [[mass]] within the gallbladder
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| ** Thickening of the [[gallbladder]] wall
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| ** A mass replacing the gallbladder
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| == Endoscopic retrograde cholangiopancreatography (ERCP)==
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| * ERCP may be helpful in diagnosing [[abnormal]] pancreaticobiliary [[ducts]] and also in collection of [[bile]]<nowiki/>s and [[biopsy]] samples <ref name="pmid12235875">{{cite journal |vauthors=Kinoshita H, Hara M, Hashino K, Hashimoto M, Nishimura K, Kodama T, Hamada S, Matsuo H, Yasunaga M, Odo M, Tamae T, Noritomi T, Hiraki M, Okuda K, Imayama H, Shirouzu K, Aoyagi S |title=A case of gallbladder cancer associated with pancreaticobiliary maljunction |journal=Kurume Med J |volume=49 |issue=1-2 |pages=61–5 |year=2002 |pmid=12235875 |doi= |url=}}</ref>
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| * ERCP is a very good tool in diagnosing filling defects of the gallbladder, It is best used for identifying [[Tumor|tumour]] [[extension]] into the [[Bile duct|bile ducts]].
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| == MRI, MRA, and MRCP ==
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| * MRI,MRA and MRCP can help in differentiate benign from malignant gallbladder lesions.<ref name="pmid16732816">{{cite journal |vauthors=Kaza RK, Gulati M, Wig JD, Chawla YK |title=Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography |journal=Australas Radiol |volume=50 |issue=3 |pages=212–7 |year=2006 |pmid=16732816 |doi=10.1111/j.1440-1673.2006.01564.x |url=}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Soo Jin|last2=Lee|first2=Jeong Min|last3=Lee|first3=Eun Sun|last4=Han|first4=Joon Koo|last5=Choi|first5=Byung Ihn|title=Preoperative staging of gallbladder carcinoma using biliary MR imaging|journal=Journal of Magnetic Resonance Imaging|volume=41|issue=2|year=2015|pages=314–321|issn=10531807|doi=10.1002/jmri.24537}}</ref>
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| * .The combination of MRI ([[magnetic resonance imaging]]) with MRA ([[magnetic resonance angiography]]) and MRCP ([[magnetic resonance cholangiopancreatography]]) is paticularly useful in diagnosing the following <ref name="KanthanSenger2015">{{cite journal|last1=Kanthan|first1=Rani|last2=Senger|first2=Jenna-Lynn|last3=Ahmed|first3=Shahid|last4=Kanthan|first4=Selliah Chandra|title=Gallbladder Cancer in the 21st Century|journal=Journal of Oncology|volume=2015|year=2015|pages=1–26|issn=1687-8450|doi=10.1155/2015/967472}}</ref><ref name="LeeKim20142">{{cite journal|last1=Lee|first1=N.K.|last2=Kim|first2=S.|last3=Kim|first3=T.U.|last4=Kim|first4=D.U.|last5=Seo|first5=H.I.|last6=Jeon|first6=T.Y.|title=Diffusion-weighted MRI for differentiation of benign from malignant lesions in the gallbladder|journal=Clinical Radiology|volume=69|issue=2|year=2014|pages=e78–e85|issn=00099260|doi=10.1016/j.crad.2013.09.017}}</ref>
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| ** Involvement of biliray tarct with a [[Sensitivity (tests)|sensitivity]]100% and [[specificity]] of 89%
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| ** Vascular invasion with a [[sensitivity]]100% and [[specificity]] of 87%
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| ** Involvement of liver with a [[Sensitivity (tests)|sensitivity]] 67% and [[Specificity (tests)|specificity]] of 89%
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| ** Involvement of lymphnodes with a [[sensitivity]]56% and [[specificity]] of 89%
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| == FDG-PET scan ==
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| * Given the rate of high [[incidence]] of [[Metastasis|metastases]] in gallbladder cancer, FDG(fluorodeoxyglucose)[[Positron emission tomography|PET]](postrion emmision tomography) [[scan]] is particularly useful in identifying [[Metastasis|metastases]].<ref name="CorveraBlumgart2008">{{cite journal|last1=Corvera|first1=Carlos U.|last2=Blumgart|first2=Leslie H.|last3=Akhurst|first3=Timothy|last4=DeMatteo|first4=Ronald P.|last5=D’Angelica|first5=Michael|last6=Fong|first6=Yuman|last7=Jarnagin|first7=William Robert|title=18F-fluorodeoxyglucose Positron Emission Tomography Influences Management Decisions in Patients with Biliary Cancer|journal=Journal of the American College of Surgeons|volume=206|issue=1|year=2008|pages=57–65|issn=10727515|doi=10.1016/j.jamcollsurg.2007.07.002}}</ref><ref name="pmid17385310">{{cite journal |vauthors=Oe A, Kawabe J, Torii K, Kawamura E, Higashiyama S, Kotani J, Hayashi T, Kurooka H, Tsumoto C, Kubo S, Shiomi S |title=Distinguishing benign from malignant gallbladder wall thickening using FDG-PET |journal=Ann Nucl Med |volume=20 |issue=10 |pages=699–703 |year=2006 |pmid=17385310 |doi= |url=}}</ref><ref name="pmid14746840">{{cite journal |vauthors=Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D |title=Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma |journal=J. Gastrointest. Surg. |volume=8 |issue=1 |pages=90–7 |year=2004 |pmid=14746840 |doi= |url=}}</ref><ref name="pmid20495711">{{cite journal |vauthors=Butte JM, Redondo F, Waugh E, Meneses M, Pruzzo R, Parada H, Amaral H, De La Fuente HA |title=The role of PET-CT in patients with incidental gallbladder cancer |journal=HPB (Oxford) |volume=11 |issue=7 |pages=585–91 |year=2009 |pmid=20495711 |pmc=2785954 |doi=10.1111/j.1477-2574.2009.00104.x |url=}}</ref><ref name="pmid18155569">{{cite journal |vauthors=Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, Jarnagin WR |title=18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer |journal=J. Am. Coll. Surg. |volume=206 |issue=1 |pages=57–65 |year=2008 |pmid=18155569 |doi=10.1016/j.jamcollsurg.2007.07.002 |url=}}</ref>
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| * PET scan is useful in diagnosing [[Abnormal|abnorma]]<nowiki/>l lesions and detecting [[residual]] disease after [[cholecystectomy]]
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| * PET scan has the ability to detect [[occult]] [[metastasis]] in patients with potentially resectable [[Tumor|tumors]] and changes the management in almost 25% of the patients
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| ==OTHER TECHNIQUES==
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| *Other techniques like percutaneous transhepatic cholecystoscopy and Percutaneous transhepatic fine needle aspiration are helpful in the evaluation of [[gallbladder]] [[Polyp|polyps]]
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| ==References== | | ==References== |