Detection Of Gallbladder Cancer Research Articles

A Systematic Review on Role of Deep Learning in CT scan for Detection of Gall Bladder Cancer

A Systematic Review on Role of Deep Learning in CT scan for Detection of Gall Bladder Cancer

Can the sampling method affect the detection of incidental gallbladder carcinoma? Comparative analysis of two sampling methods

Gallbladder cancer (GBC) is the most common biliary tract carcinoma and is commonly diagnosed incidentally in cholecystectomies performed for gallstones. GBC are mostly unrecognizable macroscopically, and sampling is therefore import. This single center study aimed to find out the effect of sampling method on the identification rate of incidental GBC by comparing random sampling and longitudinal full-thickness slice sampling, which was developed in high-incidence areas. A hospital electronic database was searched for cholecystectomy specimens submitted to the pathology department between 01/2000 and 03/2016. Cases with a preoperative clinical and/or radiological suspicion of neoplasia and cases with a macroscopically identified mass were excluded from the study. Two groups were formed according to the sampling method: “random sampling” group (Group 1, n = 10,954) and “full-thickness slice sampling” group (Group 2, n = 5254). In the first group, random samples from the fundus, body and neck were submitted in gallbladders without grossly visible pathology. In the second group, a full-thickness slice sampling protocol was performed, wherein a longitudinal full-thickness slice, including fundus, corpus-neck and the cystic duct margin was submitted for each gallbladder. Statistical comparisons of GBC incidence and clinicopathologic features was performed. In group 1, GBC prevalence was 0.6 % and low grade dysplasia (LGD) was detected in 199 cases (1.8 %). In group 2, GBC prevalence was 1.5 %, LGD was detected in 166 cases (3.2 %). The GBC rate in Group 2 was significantly (p < 0.05) higher than Group 1. The two groups did not show any statistically significant differences in age, sex and presence of gallstones (p > 0.05). In conclusion, this is the largest study comparing two grossing methods in gallbladders without preoperative clinical and/or radiological suspicion of malignancy and macroscopically identified mass. This study demonstrates the importance of systematic and algorithmic sampling in the detection of GBC.

Effect of gallbladder polyp size on the prediction and detection of gallbladder cancer.

Gallbladder polyps are relatively common. Although most gallbladder polyps are benign, some are malignant. Current guidelines state that malignancy should be suspected for polyps ≥ 10mm in diameter. We clarified the cancer detection rates in accordance with the size distribution of gallbladder polyps, and evaluated the effectiveness of the reported risk factors in predicting malignancy. In this retrospective case-control study, our institutional database was searched to identify patients who underwent laparoscopic cholecystectomy for benign or malignant gallbladder polyps at Sada Hospital, Japan. The chi-squared test was used to analyze the risk factors for malignancy. There were 227 protruding gallbladder lesions. The 206 benign polyps had a diameter of 2-21mm, while the 21 malignant polyps were 7-60mm. The cancer detection rates were 16.4% for lesions ≥ 10mm, 55.9% for lesions ≥ 15mm, and 94.1% for lesions ≥ 20mm. Of the benign lesions, cholesterol polyps were the most frequent (50-100%) in all size ranges, even in large lesions (≥ 15mm). The sessile lesion morphology was significantly more frequent in malignant (60%) than benign lesions (3.4%, p < 0.00001). Multiple polyps were frequently diagnosed not only as cholesterol polyps (81.1%), but also as adenomas (60%); adenomas were found as a single adenoma within other types of polyps. There were two cases of malignant small gallbladder polyps (< 10mm); these lesions met the surgical indications of a size increase during observation or a sessile morphology. The cancer detection rate increased significantly with an increase in the lesion size. Risk factors such as a sessile polyp morphology or an increase in lesion size were effective in predicting malignancy for small gallbladder polyps. It might be difficult to accurately predict the pathologic diagnoses of gallbladder polyps preoperatively, as cholesterol polyps were most frequent, even in the large size range.

Ability of FDG‐PET/CT in the detection of gallbladder cancer

To assess the value of FDG-PET/CT in the evaluation of gallbladder carcinomas (GBC). A prospective cohort of patients with suspicion of or confirmed GBC was studied with FDG-PET/CT. Diagnostic accuracy parameters were calculated in comparison with pathology and/or the clinical course of patients. Clinical impact of PET/CT imaging was estimated. Forty-nine patients were enrolled (34 malignant tumors, 15 benign lesions; 37 staging, 12 restaging). Overall diagnostic accuracy was 95.9% for the diagnosis of the primary lesion, 85.7% for lymph node involvement and 95.9% for metastatic disease. Mean SUVmax in malignant gallbladder lesions was 7.92 ± 6.25 Analysis of ROC curves showed a SUVmax cut-off value of 3.62 for malignancy (S: 78.1%; Sp: 88.2%). Diagnostic accuracy in the restaging group reached 100%. FDG-PET/CT changed the management of 22.4% of the population. Diagnosis of malignancy or benignity of suspicious gallbladder lesions is accurately made with FDG PET/CT, allowing a precise staging of GBC due to its ability to identify unsuspected metastatic disease. SUVmax has a complementary role in addition to visual analysis.

English

OBJECTIVE- To determine the prevalence of carcinoma of the gallbladder in the specimens following routine cholecystectomy. STUDY DESIGN- Observational case series study Place & Duration of study- Department of Surgery, Rama Medical college Hospital and Research center, from April 2009 to March 2013. MATERIALS AND METHOD-All patients with symptomatic gallstone disease of both sex having age range between 15 to 70 year were included. Patients with pre diagnosed Gallbladder malignancy, Gallbladder mass, Empyema Gallbladder and Gallstones associated with obstructive jaundice were excluded. All cholecystectomized gall bladder specimens were sent for histopathological examination. RESULTS-Five hundred and twenty patients (520) including 104 males and 416females (M: F ratio 1:4) aged15-70 year and having a mean age of 41.7 year (± SD 2.4), were included in this retrospective study. Commonest presentations were pain in the right hypochondrium and a positive Murphy's sign (87.71%) followed by dyspepsia (55%), nausea, vomiting (40%), pyrexia (31.92%) and weight loss (05%). Twenty two (4.23%) patients had a diagnosis of malignancy of gallbladder at histopathology examination. Mean age for patients with malignancy was 55.25 year with a male to female ratio of 01:10. Well differentiated adenocarcinoma was reported in 45.45% cases, moderately differentiated in 36.36%, poorly differentiated in 09.09% and undifferentiated in 09.09%patients CONCLUSION-Though early detection and treatment has declined the incidental Gall Bladder carcinoma occurrence, but routine histopathology of cholecystectomized Gall Bladder is necessary for early detection of Gall Bladder Cancer. KEY WORDS-Cholecystectomy, Gallstones, Histopathology.

Significance of tumour markers in cancer of gall bladder

In India, GI tract cancer is one of the ten leading cancers. Among Indian males it stands second to oral cancer and in females, it shares the third place. Most common malignant disorder of GIT is seen in our country that of liver, bile, gall bladder, pancreas, bileduct and colorectal. Aim: To see the significance of tumour markers in gall bladder cancer. Materials and Methods:This study comprise 225 cases of GI tract cancers was carried for more than two years. Of these, 22 subjects had gallbladder cancer. Tumour markers viz. CA19-9, CEA and AFP were assayed pre and post-operative cases and their role in gallbladder cancer was evaluated. Results: It was observed that serum concentration of CA 19-9 increased with advancing stage, but the same is not true for AFP and CEA. Sensitivity of these markers AFP, CA 19-9 and CEA in the detection of gall bladder cancer was determined. CA 19-9 is the most sensitive of all the three tumour markers in the detection of gall bladder cancer. Conclusion: The combination of CA19-9 and CT (or US) is a reasonable, cost-effective, noninvasive approach to establishing the diagnosis of pancreatic, cholangitic, or biliary cancer in nonicteric patients.

Gallbladder cancer in India: A dismal picture

Gallbladder cancer (GBC) is one of the most common gastrointestinal malignancies. The data regarding GBC are, however, limited. Records of 634 patients with GBC over a 10-year period were examined with regard to the clinical presentation, investigative findings, treatment, operative findings and outcome. The mean age of patients was 51 +/- 11 years and men : women ratio was 0.36:1.00. Pain, jaundice and hepatomegaly were seen in 81.0%, 76.0% and 61.5% patients, respectively. On imaging, a mass replacing the gallbladder was seen in 73% patients. Gallstones were present in 54% patients. Surgery was carried out in 291 (46%) patients and endoscopic treatment in 72 (19%) patients but no intervention was carried out in the remaining patients because of disseminated disease. Among the patients who were operated on, 2.0% had stage I GBC, 3.4% stage II, 17.5% stage III, 47.0% stage IVa and 29.8% stage IVb. Radical resection was possible in 133 (46%) patients. The 30-day mortality was 10% with most (90%) deaths in patients with stage IV disease. The median survival after simple cholecystectomy and radical surgery was 33.5 and 12.0 months, respectively. However, among those who underwent debulking, palliative bypass or exploratory laparotomy alone, the survival ranged between 1 and 3 months. Logistic regression analysis showed that only radical resection improved the long-term survival (P < 0.05). The majority of patients with GBC in India have advanced unresectable disease. Detection of GBC at an early stage is incidental and rare but is associated with long-term survival. Radical surgery, when feasible, is the only option for achieving long-term survival.

7161 Long-term results of percutaneous cholecystolithotomy using flexible choledochoscope for acute calculous cholecystits.

Aims: To evaluate outcomes of long-term follow up after percutanesous cholecystolithotomy using choledochoscope for acute calculous cholecystitis. Methods: Medical records of 72 patients with acute calculous cholecystitis undergoing percutaneous cholecystolithotomy from March 1989 to November 1999 were retrospectively reviewed. Stone removal was performed by a flexible choledochoscope via the matured fistra track around the drainage catheter using either basket catheter or electrohydraulic lithotriptor. To determine combined gallbladder cancer, frequent bile cytology were performed and biopsies were endoscopically obtained. The drainage catheter was withdrawn after endoscopic confirmation of complete stone removal. After successful treatment, patients were followed up with bimonthly interview and ultrasound every six months up to the detection of stone recurrence or subsequent cholecystectomy. Adjuvant bile acid therapy was administered to them. Results: With one exception, complete stone removal was successfully achieved (success rates; 98.6%). One patient underwent cholecystectomy due to perforation of cystic duct by electrohydraulic lithotripsy. Three patients underwent cholecystectomy right after stone removal; gallbladder cancer was identified in two and pancreatic cancer was in one.With these four exceptions, 68 patients were followed up during a mean of 54 months (1 to 120 months). Of these, 13 cases were died (4; myocardial infarction, 4; stroke, 2; heart failure, 1; lung cancer, 1; gallbladder cancer, 1; unknown), 6, no contact due to address change, and 5, underwent cholecystectomy for other diseases (2; gastric cancer, 2; CBD stone, 1; gallbladder cancer) without stone recurrence up to their end points. Stone recurrence was observed in 10 patients (14.7%). Six of the 10 patients with recurrent calculi were asymtomatic. Gallbladder cancer developed in 3 patients (4.4%). The periods of detection of gallbladder cancer from complete stone removel were 12, 42, and 60 months. There is no procedure related mortality. Procedure related complication was observed in the only one patient (1.4%) as cystic duct perforation. Conclusion: Percutaneous stone removal for acute calculous cholecystitis is safe and effective with low recurrence rates in long-term follow up. However, there is the risk of developing gallbladder cancer even after stone removal. Therefore, perecutaneous gallstone removal is beneficial in patients with surgical high risk.

第25回日本総合健診医学会学術大会講演抄録集 腹部超音波検診による胆嚢癌の早期発見

第25回日本総合健診医学会学術大会講演抄録集 腹部超音波検診による胆嚢癌の早期発見

第20回日本総合健診医学会学術大会講演抄録集 腹部超音波スクリーニングにて発見された胆嚢癌症例の分析

第20回日本総合健診医学会学術大会講演抄録集 腹部超音波スクリーニングにて発見された胆嚢癌症例の分析