Wall thickness is an important predictor of gallbladder malignancy in patients surgically treated for gallbladder disease

Abstract

Background: Gallbladder wall thickening is relatively common on imaging. GB thickening is a frequent finding caused by a spectrum of conditions. It is observed in many intracholecystic as well as intrinsic GB conditions. The study aimed to determine the relationship between the wall thickness of gallbladder malignancy in patients with gallbladder diseases. Methods: The Prospective cross-sectional and observational study was carried out in the department of general surgery and hepato-biliary-pancreatic surgery, BIRDEM general hospital, Dhaka from August 2019 to February 2021. Patients admitted to the general surgery and hepato-biliary-pancreatic surgery department of BIRDEM hospital who underwent gallbladder surgery were recruited for this study. Consecutive sampling was done in this study. Results: 86% of patients underwent laparoscopic cholecystectomy, while 14% had open cholecystectomy, of which 9 were simple and 6 were radical en block. The average wall thickness of the gallbladder was 7.5mm, with 52.7% moderate thickness, 37.3% mild, and 10% severe. 20% of patients with gallbladder disease had carcinoma, and the most common diagnosis was chronic calculous cholecystitis. A cut-off value of 8.25mm for gallbladder wall thickness had 81.8% sensitivity and 72.7% specificity in predicting carcinoma, and gallbladder wall thickness ≥8.25 mm had the highest significant odds ratio in predicting gallbladder carcinoma after adjusting for age, gender, and smoking history. Conclusions: GB carcinoma patients had significantly thicker gall bladder walls (9.80 vs 6.93 mm) and a higher frequency of severe GB wall thickness (36.36 vs. 3.41%) compared to patients without GB carcinoma. Gall bladder wall thickness is an important variable requiring consideration for the proper evaluation to exclude malignancy for undertaking proper surgical management, thus improving the long-term outcome.