Gallbladder cancer screening
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
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.
Screening
- According to the NCCN guidelines, screening for gallbladder cancer patients is recommended with 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.
Ultrasound
- when gallbladder pathology is suspected ultrasonography is most commonly the first choice for screening.
- Sensitivity and specificity of ultrasound screening is 85% and 80%.
- A High-resolution contrast-enhanced ultrasonography identifies up to 70–90% of polypoid gallbladder lesions.[1]
- Gallbladder cancer on ultrasound have one of the following feartures[2]
- 1) A mass in the gallbladder
- 2) A polyp in the gallbladder
- 3) Asymmetric wall thickening of the gallbladder
- Polyps which are over 1 cm in diameter have higher chance to contain an invasive cancer than smaller ones.[3]
- With Contrast-enhanced ultrasonography gallbladder cancer shows an “eruption sign”[4]
Computer Tomography (CT)
- The most common non-invasive imaging studies for evaluating gallbladder cancer include CT.
- In diagnosis and staging of GBC CT scan is useful.
- Ct scan is helpful in detection of invasion to adjacent tissues like liver, lymphadenopathy and other organs
- In CT scan features of gallbladder cancer include[5][6]
- Polypoid mass within the gallbladder
- Thickening of the gallbladder wall
- A mass replacing the gallbladder
Endoscopic retrograde cholangiopancreatography (ERCP)[7]
- ERCP may be helpful in diagnosing abnormal pancreaticobiliary ducts and also in collection of biles and biopsy samples
- ERCP is a very good tool in diagnosing filling defects of the gallbladder, It is best used for identifying tumour extension into the bile ducts.
MRI, MRA, and MRCP
- MRI,MRA and MRCP can help in differentiate benign from malignant gallbladder lesions.[8][9]
- .The combination of MRI (magnetic resonance imaging) with MRA (magnetic resonance angiography) and MRCP (magnetic resonance cholangiopancreatography) is paticularly useful in diagnosing the following [10][11]
- Involvement of biliray tarct with a sensitivity100% and specificity of 89%
- Vascular invasion with a sensitivity100% and specificity of 87%
- Involvement of liver with a sensitivity 67% and specificity of 89%
- Involvement of lymphnodes with a sensitivity56% and specificity of 89%
FDG-PET scan[12][13][14][15][16]
- Given the rate of high incidence of metastases in gallbladder cancer, FDG(fluorodeoxyglucose)PET(postrion emmision tomography) scan is particularly useful in identifying metastases.
- PET scan is useful in diagnosing abnormal lesions and detecting residual disease after cholecystectomy
- PET scan has the ability to detect occult metastasis in patients with potentially resectable tumors and changes the management in almost 25% of the patients
OTHER TECHNIQUES
- Other techniques like percutaneous transhepatic cholecystoscopy and Percutaneous transhepatic fine needle aspiration are helpful in the evaluation of gallbladder polyps
References
- ↑ Inui K, Yoshino J, Miyoshi H (2011). "Diagnosis of gallbladder tumors". Intern. Med. 50 (11): 1133–6. PMID 21628925.
- ↑ Kanthan R, Senger JL, Ahmed S, Kanthan SC (2015). "Gallbladder Cancer in the 21st Century". J Oncol. 2015: 967472. doi:10.1155/2015/967472. PMC 4569807. PMID 26421012.
- ↑ Wibbenmeyer LA, Sharafuddin MJ, Wolverson MK, Heiberg EV, Wade TP, Shields JB (1995). "Sonographic diagnosis of unsuspected gallbladder cancer: imaging findings in comparison with benign gallbladder conditions". AJR Am J Roentgenol. 165 (5): 1169–74. doi:10.2214/ajr.165.5.7572497. PMID 7572497.
- ↑ Vijayakumar A, Vijayakumar A, Patil V, Mallikarjuna MN, Shivaswamy BS (2013). "Early diagnosis of gallbladder carcinoma: an algorithm approach". ISRN Radiol. 2013: 239424. doi:10.5402/2013/239424. PMC 4045520. PMID 24959553.
- ↑ Deshmukh SD, Johnson PT, Sheth S, Hruban R, Fishman EK (2013). "CT of gallbladder cancer and its mimics: a pattern-based approach". Abdom Imaging. 38 (3): 527–36. doi:10.1007/s00261-012-9907-1. PMID 22581235.
- ↑ Vijayakumar A, Vijayakumar A, Patil V, Mallikarjuna MN, Shivaswamy BS (2013). "Early diagnosis of gallbladder carcinoma: an algorithm approach". ISRN Radiol. 2013: 239424. doi:10.5402/2013/239424. PMC 4045520. PMID 24959553.
- ↑ 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 (2002). "A case of gallbladder cancer associated with pancreaticobiliary maljunction". Kurume Med J. 49 (1–2): 61–5. PMID 12235875.
- ↑ Kaza RK, Gulati M, Wig JD, Chawla YK (2006). "Evaluation of gall bladder carcinoma with dynamic magnetic resonance imaging and magnetic resonance cholangiopancreatography". Australas Radiol. 50 (3): 212–7. doi:10.1111/j.1440-1673.2006.01564.x. PMID 16732816.
- ↑ Kim, Soo Jin; Lee, Jeong Min; Lee, Eun Sun; Han, Joon Koo; Choi, Byung Ihn (2015). "Preoperative staging of gallbladder carcinoma using biliary MR imaging". Journal of Magnetic Resonance Imaging. 41 (2): 314–321. doi:10.1002/jmri.24537. ISSN 1053-1807.
- ↑ Kanthan, Rani; Senger, Jenna-Lynn; Ahmed, Shahid; Kanthan, Selliah Chandra (2015). "Gallbladder Cancer in the 21st Century". Journal of Oncology. 2015: 1–26. doi:10.1155/2015/967472. ISSN 1687-8450.
- ↑ Lee, N.K.; Kim, S.; Kim, T.U.; Kim, D.U.; Seo, H.I.; Jeon, T.Y. (2014). "Diffusion-weighted MRI for differentiation of benign from malignant lesions in the gallbladder". Clinical Radiology. 69 (2): e78–e85. doi:10.1016/j.crad.2013.09.017. ISSN 0009-9260.
- ↑ Corvera, Carlos U.; Blumgart, Leslie H.; Akhurst, Timothy; DeMatteo, Ronald P.; D’Angelica, Michael; Fong, Yuman; Jarnagin, William Robert (2008). "18F-fluorodeoxyglucose Positron Emission Tomography Influences Management Decisions in Patients with Biliary Cancer". Journal of the American College of Surgeons. 206 (1): 57–65. doi:10.1016/j.jamcollsurg.2007.07.002. ISSN 1072-7515.
- ↑ Oe A, Kawabe J, Torii K, Kawamura E, Higashiyama S, Kotani J, Hayashi T, Kurooka H, Tsumoto C, Kubo S, Shiomi S (2006). "Distinguishing benign from malignant gallbladder wall thickening using FDG-PET". Ann Nucl Med. 20 (10): 699–703. PMID 17385310.
- ↑ Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D (2004). "Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma". J. Gastrointest. Surg. 8 (1): 90–7. PMID 14746840.
- ↑ Butte JM, Redondo F, Waugh E, Meneses M, Pruzzo R, Parada H, Amaral H, De La Fuente HA (2009). "The role of PET-CT in patients with incidental gallbladder cancer". HPB (Oxford). 11 (7): 585–91. doi:10.1111/j.1477-2574.2009.00104.x. PMC 2785954. PMID 20495711.
- ↑ Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, Jarnagin WR (2008). "18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer". J. Am. Coll. Surg. 206 (1): 57–65. doi:10.1016/j.jamcollsurg.2007.07.002. PMID 18155569.