Staging Of Gallbladder Carcinoma Research Articles

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Trends in primary gallbladder cancer incidence and incidence-based mortality in the United States, 1973 to 2015.

e16133 Background: Primary gallbladder carcinoma (GBC) is the most common biliary tract cancer with poor survival despite aggressive treatment. The purpose of our study was to investigate the trends of GBC incidence and incidence-based mortality (IBM), as well as to identify the factors responsible for any observed changes. Methods: GBC cases diagnosed between 1973 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results database (SEER) database. Incidence and IBM rates age-adjusted to the 2000 US standard population were calculated and were stratified according to population and tumor-associated characteristics. Joinpoint Regression Analysis program was used to calculate the annual percent changes (APCs) for trend analysis. Results: Among the 10,792 patients with GBC, there was a predominance of white (81%) and female (71%) patients. The overall incidence rate was 1.086 (95% CI: 1.065 to 1.106) and the overall IBM rate was 0.995 (95% CI: 0.976 to 1.015). GBC incidence decreased by 1.645% (95% CI: 1.448 to 1.842, p < 0.001) per year, but the decreasing trend was only statistically significant from 1973 to 2002, after which the incidence rates stabilized. Conversely, IBM decreased by 1.689% (95% CI: 1.217 to 2.159, p < 0.001) per year from 1980 to 2015; the degree of decline in IBM rates during 1997-2015 (-1.194, 95% CI: -1.680 to -0.705, p < 0.001) was lower compared to that during 1980-1997 (-3.132, 95% CI: -3.682 to -2.578, p < 0.001). Mortality rates of GBC decreased in all age groups and in all races except for African American. There was a significant decrease in IBM in all SEER stages of GBC, except for distant stage GBC. Conclusions: GBC incidence and IBM rates have been decreasing over the last 40 years. However, the decrease in incidence and IBM appeared to have plateaued in the last two decades. The roles of increasing widespread use of laparoscopic cholecystectomy and use of newer treatment modalities, such as adjuvant chemotherapy and radiation, need to be investigated further.[Table: see text]

EGFR and HER2neu Expression in Gall Bladder Carcinoma and Its Association with Clinicopathological Parameters - An Institutional Experience from North India

Objective: Gallbladder cancer (GBC) is the most common biliary tract malignancy found worldwide with very high incidence in North India especially Delhi region. It is characterized by poor prognosis and ineffective treatment especially in advanced stage. The aim of this study was to evaluate EGFR and HER2/neu immunoexpression in cancer patients and to correlate it with the clinicopathological parameters so as to identify GBC patients who can benefit from targeted therapy.Methods: Present study was conducted in the Department of Pathology, Hamdard Institute of Medical Sciences & Research, New Delhi. A total of 40 cases of Gallbladder carcinoma (GBC) were evaluated for Immunohistochemical expression of EGFR and HER2/neu. Clinicopathological parameters of GBC were studied and correlated with immunoexpression of EGFR and HER2 /neu. Result: The mean age of the GBC patients was 55.9 years with 90% being females. On histopathology, 34(85%) cases were conventional adenocarcinoma. The EGFR expression was positive in 29/40 cases (72.5%). It was significantly more positive in poorly differentiated grade and advanced stages of gall bladder carcinoma (P<0.05). The expression of HER2/neu was positive in 13/40 cases (32.5%). It was significantly more positive in well differentiated gall bladder carcinoma (P<0.05). Immunoexpression of EGFR was inversely related with HER2/neu expression and this association was statistically significant.Conclusion: Among GBC patients, EGFR expression and HER2/neu expression was 72.5% and 32.5%, respectively. Significant EGFR expression was seen in poorly differentiated and advanced stage cancers while significant HER2/neu expression was seen in well differentiated gall bladder carcinomas. To conclude, these two markers HER2/neu and EGFR can be used as predictive and prognostic markers respectively, with rationale to further explore the use of anti-HER2 and anti- EGFR therapy in gall bladder cancer.

Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population.

BackgroundGallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population.MethodsA retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used.ResultsOf 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031).ConclusionCholecystectomy needs to be considered early in the management of small-sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.

Impact of Pre-operative Positron Emission Tomography - Computed Tomography for Management of Gallbladder Cancer

Background: Prognosis of gallbladder carcinoma is poor; surgery with R0 resection remains the only chance for long-term survival for these patients.Extensive evaluation is mandatory to accurately define the tumor stage,regional lymph nodes and distant metastases to identify those patients who may benefit from surgery.The purpose of this study was to assess the diagnostic value of PET-CT in relation to a conventional imaging modality,CECT for patients with gallbladder cancer. Methods: This study was prospective observational study conducted at tertiary care institute.Seventy patients with suspected gallbladder cancer who underwent both PET-CT and MDCT for initial staging were included in our study.Results of these two imaging modalities for evaluating primary tumors, regional lymph nodes and distant metastases were compared with the final diagnoses based on histopathological examination. Results: PET-CT demonstrated no significant advantage over MDCT for the diagnosis of a primary tumor.PET-CT showed a significantly higher accuracy (90.8vs.80.0%,P=0.04) than MDCT for diagnosis of regional lymph node metastasis. PET-CT showed significantly higher sensitivity (92.3vs.61.5%,P=0.04) than MDCT in the diagnosis of distant metastasis.Addition of PET-CT changed management in 10 patients(14.3%).In seven patients,radical resection was avoided due to presence of distant lymph nodal disease or distant metastases diagnosed on PET-CT.In three patients with suspicious CT finding,PET was negative for malignancy. Conclusions: In patients with potentially recectable gallbladder carcinoma on primary imaging, PET-CT may be helpful in detecting distant nodal metastasis and unsuspected metastatic disease that may preclude patients from surgical resection.Addition of preoperative PET-CT in staging of gallbladder carcinoma, also result in change of management in significant number of patient.

Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the National Cancer Data Base.

Gallbladder carcinoma (GBC) has a poor prognosis. Studies demonstrated that teaching facilities may provide a lower risk of mortality in patients undergoing pancreatic and colon resection vs nonteaching facilities. We hypothesized that survival rates are higher in academic cancer centers (ACCs) vs community cancer centers (CCCs). Patients with all stages of GBC were identified from the National Cancer Database (2007-2012). Propensity score matching adjusted for selection bias. Descriptive statistics were calculated for all variables. Overall survival (OS) was compared by facility type (ACC vs CCC) and case volume (low vs high) via multivariable Cox proportional hazards regression. A total of 7967 patients met the inclusion criteria. Following propensity matching, 2801 patients were analyzed from each facility type. Median OS following surgery was higher for ACC (20.99 months, 95% confidence interval [CI], 19.61-22.64, P = .002) than CCC (17.68 months, 95% CI, 16.46-19.25). Following Cox modeling, GBC treatment at ACCs was a protective factor for OS (adjusted hazard ratio 0.876, 95% CI, 0.801-0.958, P = .004). GBC treatment at ACCs is an independent predictor of OS. High volume ACCs are associated with improved OS compared with low volume ACCs. The site of care and case volume in ACCs may contribute to improved survival outcomes.

Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the national cancer data base

Background and objectives Gallbladder carcinoma (GBC) has a poor prognosis. Studies demonstrated that teaching facilities may provide a lower risk of mortality in patients undergoing pancreatic and colon resection vs nonteaching facilities. We hypothesized that survival rates are higher in academic cancer centers (ACCs) vs community cancer centers (CCCs). Methods Patients with all stages of GBC were identified from the National Cancer Database (2007-2012). Propensity score matching adjusted for selection bias. Descriptive statistics were calculated for all variables. Overall survival (OS) was compared by facility type (ACC vs CCC) and case volume (low vs high) via multivariable Cox proportional hazards regression. Results A total of 7967 patients met the inclusion criteria. Following propensity matching, 2801 patients were analyzed from each facility type. Median OS following surgery was higher for ACC (20.99 months, 95% confidence interval [CI], 19.61-22.64, P = .002) than CCC (17.68 months, 95% CI, 16.46-19.25). Following Cox modeling, GBC treatment at ACCs was a protective factor for OS (adjusted hazard ratio 0.876, 95% CI, 0.801-0.958, P = .004). Discussion GBC treatment at ACCs is an independent predictor of OS. High volume ACCs are associated with improved OS compared with low volume ACCs. The site of care and case volume in ACCs may contribute to improved survival outcomes.

Significance of HER2 and Ki-67 in Preneoplastic Lesions and Carcinoma of Gallbladder.

HER2 is an oncoprotein which is overexpressed in several cancers including breast and stomach. Several studies have shown that HER2 is overexpressed in gallbladder cancer and in precancerous lesions. The present study was undertaken to assess pattern and level of expression of HER2 in metaplasia, dysplasia, and different stages of gallbladder carcinoma, which would determine its suitability as a prognostic biomarker in neoplastic transformation of gallbladder epithelium. The study was also aimed at to find the significance of Ki-67 index in these lesions. One hundred and twenty-eight patients who underwent cholecystectomy comprised the study group. Among them, 108 (84.4%) specimens showing metaplasia, dysplasia, and carcinoma on routine histopathology were considered as cases and 20 (15.6%) specimens of chronic cholecystitis having non-metaplastic mucosa were considered as control. Immunohistochemistry (IHC) was performed for HER2 and Ki-67. For HER2 interpretation ASCO/CAP guideline for breast cancer was followed. Chi-square test was used to find out the significance of HER2 expression in dysplasia/metaplasia/carcinoma. The ANOVA and Tukey-Kramer Multiple Comparisons Test were used for determining the association of Ki-67 with malignant transformation. Overexpression of HER2 was observed in 48% (n = 12) of adenocarcinomas, 58% (n = 7) of high-grade dysplasia, 47% (n = 8) of low-grade dysplasia, and 74% (n = 25) of intestinal metaplasia. Ki-67 index increases in a non-linear fashion as the precursor lesions progress toward malignancy. In the future, these markers might be used as a prognostic biomarker for gallbladder carcinoma and its precursor lesions and it might become a valid indication for targeted therapies for gallbladder cancer.

Treatment approach for gall bladder and extrahepatic bile duct cancer

Although the treatment and diagnostic regimens of gall bladder carcinoma and extrahepatic bile duct cancer have improved over the past years, the outcome and overall survival as prognostic values still remain poor. Early tumor stages of gall bladder carcinoma are the only exception. This article focuses on the latest surgical therapy approaches including neoadjuvant, adjuvant and palliative therapy regimens. Neoadjuvant treatment concepts have so far been insufficiently evaluated and can therefore only be recommended within the framework of studies. In patients with primary resectable tumors there are so far no indications for improved results after neoadjuvant therapy. Radical R0 resection still remains the only curative treatment option; however, an advanced and inoperable stage is often already present at the time of diagnosis There are no uniform adjuvant treatment concepts and no standards evaluated by studies. Due to the currently available data, adjuvant radiochemotherapy and chemotherapy can also only be recommended within or as part of clinical trials. Palliative chemotherapy should only be used in advanced tumor stages and depending on the condition of the patient. To sustainably improve treatment strategies for advanced gall bladder carcinoma and extrahepatic bile duct cancer, uniform adjuvant as well as neoadjuvant therapy regimens need to be developed after evaluation in prospective randomized trials. This is the only way to improve the still poor prognosis of these tumor entities.

Role of Multidetector Computed Tomography (MDCT) in Evaluation of Gallbladder Malignancy and its Pathological Correlation in an Indian Rural Center

Clinically or sonographically suspected gallbladder carcinoma was evaluated on multidetector computed tomography. Based on the spectrum of multidetector computed tomography findings, staging of gallbladder carcinoma was done. Multidetector computed tomography diagnosis was compared with pathological diagnosis. This is a prospective study carried out in 100 patients at a rural Indian center between May 2012 and June 2015. Multidetector computed tomography was performed in all the cases and the findings were observed. Based on the radiological spectrum, staging of gallbladder carcinoma was done. The diagnosis was confirmed by ultrasound guided fine needle aspiration cytology/histopathological examination of surgical specimens. The most common multidetector computed tomography findings noted by us were mass replacing gallbladder, followed by diffuse/focal gallbladder wall thickening and polypoidal mass. Other findings noted were cholelithiasis, liver infiltration, intra hepatic biliary dilatation, liver metastases, portal vein invasion, antroduodenal and hepatic flexure involvement. Ultrasonography guided fine needle aspiration cytology done in all cases was positive in 92 cases and inconclusive in eight cases. Surgery was performed in only 22 patients, and histopathological findings were correlated with multidetector computed tomography findings. Multidetector computed tomography is also reliable in detection of extension of tumor and lymph nodes. multidetector computed tomography plays a major role in evaluating and staging of carcinoma gallbladder. It also guides the surgeons for operatibility and resectability of tumour.

Utility of 18F-FDG PET/CT for the diagnosis and staging of gallbladder carcinoma

Objective To investigate the value of 18F-FDG PET/CT combined with clinical data in the diagnosis of gallbladder carcinoma and to assess the role of 18F-FDG PET/CT in tumor staging. Methods 18F-FDG PET/CT and clinical data of 54 patients (28 males, 26 females, age range 18-82 years) with suspected gallbladder carcinoma from March 2009 to March 2014 were retrospectively analyzed. The results of histopathology and clinical follow-up were taken as golden standard. The diagnostic value of 18F-FDG PET/CT for gallbladder carcinoma was determined by the qualitative and quantitative methods. Serum CEA, CA19-9 and WBC count were evaluated for discriminating 18F-FDG-avid malignant and benign diseases. According to the final clinical staging, the role of 18F-FDG PET/CT for tumor staging was assessed. Data were analyzed by two-sample t test, χ2 test and McNemar test. Results (1) Gallbladder carcinoma was diagnosed in 27 cases and the gallbladder benign diseases in other 27 cases. 18F-FDG PET/CT showed positive results in 42 patients including true positive in 27 patients and false positive in other ones. When focal high uptake of 18F-FDG in the gallbladder and SUVmax of 6.6 in the lesions were used as the qualitative and quantitative standards, the diagnostic sensitivity, specificity, and accuracy of the two methods for gallbladder carcinoma were 100%(27/27) vs 81.5%(22/27), 44.4%(12/27) vs 70.4%(19/27), 72.2%(39/54) vs 75.9%(41/54), respectively (χ2=3.711 and 0.193, both P>0.05). There were no much difference for the positive rate of serum CEA and CA19-9 levels between the patients with early staged gallbladder carcinoma and those with 18F-FDG-avid benign diseases(χ2=0.529 and 0.045, both P>0.05). However, the rate of increased WBC count in patients with 18F-FDG-avid benign diseases was significantly higher than that in patients with early staged gallbladder carcinoma (14/15 vs 1/6, χ2=12.343, P<0.05). (2) Nearly 59.3% (16/27) patients with gallbladder carcinoma were upstaged due to the findings by whole body 18F-FDG PET/CT. The sensitivity, specificity of 18F-FDG PET/CT for diagnosing lymph node metastases and distant metastases were 18/19, 7/8 and 17/17, 9/10, respectively. Conclusions 18F-FDG PET/CT has low specificity for differentiating 18F-FDG-avid gallbladder benign disease and early staged gallbladder carcinoma, but it may be beneficial to the diagnosis that combining PET/CT with WBC count. 18F-FDG PET/CT is helpful for the staging of gallbladder carcinoma. Key words: Gallbladder neoplasms; Tomography, emission-computed; Tomography, X-ray computed; Diagnosis, differential; Neoplasm staging; Deoxyglucose

The role of endoscopic ultrasound in the diagnosis of gallbladder diseases.

Endoscopic ultrasound (EUS) has recently played an increasing role in the diagnosis of gallbladder diseases. This review aims to summarize the role of EUS in the diagnosis of gallbladder lesions. EUS provides high-resolution images that can improve the diagnosis of gallbladder polypoid lesions and microlithiasis, in addition to evaluating gallbladder thickness and staging of gallbladder carcinoma. Contrast-enhancing agents may be useful for the differential diagnosis of gallbladder lesions, but the evidence of their effectiveness is still limited and further studies are required in this area to establish its usefulness. Endoscopic ultrasound combined with fine needle aspiration has played an increasing role in providing histological diagnosis of gallbladder tumors in addition to gallbladder thickening.

Expression of epidermal growth factor receptor, p53, Bcl2, vascular endothelial growth factor, cyclooxygenase-2, cyclin D1, human epidermal receptor-2 and Ki-67: Association with clinicopathological profiles and outcomes in gallbladder carcinoma.

Background:The present study observed the expression levels of epidermal growth factor receptor (EGFR), p53, Bcl2, vascular endothelial growth factor (VEGF), cyclooxygenase-2 (cox-2), cyclin D1, human epidermal receptor-2 (HER-2) and Ki-67 in gallbladder carcinoma (GBC) and their association with clinicopathological profiles and disease outcomes.Materials and Methods:Fifty consecutive samples of cholecystectomy/biopsies from GB bed (archived formalin fixed paraffin embedded tissue blocks of different stages of GBC) were included, and patient details related to their demographic profile, investigations, tumor profile, treatment, and follow-up were recorded. Immunohistochemistry was performed to study the expression levels.Results:Overexpression of EGFR, p53, Bcl2, VEGF, cox-2, cyclin D1 and HER-2 was observed as 74%, 44%, 8%, 34%, 66%, 64%, and 4%, respectively. Association of Bcl2 overexpression in mucinous morphology (40%, P = 0.045), cox-2 overexpression in early stage (I/II) tumors (87.5%, P = 0.028) and VEGF overexpression in alive patients (47.1%, P = 0.044) was observed. Co-expression of EGFR and p53 were statistically significant (P = 0.033). Ki-67 labeling index was significantly higher in patients in age group <40 years (P = 0.027), and poorly differentiated tumors (P = 0.023). Advanced disease and poorly differentiated tumors showed a significantly poor median survival (P < 0.05).Conclusion:EGFR, cox-2 and cyclin D1 were largely overexpressed. Advanced tumor stages and poorly differentiated tumors are predictors of poor survival.

Role of multidetector computed tomography (MDCT) in diagnosis and staging of gall bladder carcinoma

BackgroundCarcinoma of the gall bladder is the fifth most common malignancy of the gastrointestinal tract after colorectal, pancreatic, gastric and esophageal carcinomas. Aim of the workTo study the role of multidetector computed tomography in the diagnosis and staging of gall bladder carcinoma. Subjects and methodsThis study included twenty-five patients presented to us during the period from June 2011 till May 2012 and were diagnosed radiologically by multidetector computed tomography as carcinoma of the gall bladder and the diagnosis was confirmed histopathologically. All the patients were subjected to ultrasonography followed by multidetector computed tomographic imaging using triphasic examination technique. ResultsAmong the twenty-five patients included in this study there were fifteen females and ten males. Their ages ranged from 50 to 70years old (average 60years). All the patients were radiologically diagnosed as gall bladder carcinoma based on the multidetector computed tomographic findings. Infiltrating masses were detected in fifteen patients (60%), Intraluminal polypoidal masses were detected in nine patients (36%) while one patient (4%) presented with mural thickening of the gall bladder wall. ConclusionWe conclude that multidetector CT is the diagnostic tool of choice in the detection and staging of gall bladder carcinoma.

The varying faces of gall bladder carcinoma: pictorial essay

The objective of this review is to highlight the pertinent imaging features and potential pitfalls in the diagnosis and staging of gall bladder carcinoma. This condition is notoriously non-specific on imaging on many occasions, particularly in its early stages; gall bladder carcinoma shows numerous features that overlap with a large number of benign conditions, leading to delayed diagnosis and incurable disease. Radiologists should be familiar with its typical and atypical imaging features.

Determination of expressions of KiSS-1 and KAI-1 proteins in gallbladder carcinoma by tissue microarrays

We investigated the expression levels of KiSS-1 and KAI-1 in gallbladder carcinoma and their relationship with clinicopathologic parameters and metastasis potential. Pathological specimens from 59 gallbladder carcinoma tissues (including 23 invasion tissues), matched 7 para-tumor and 6 normal gallbladder tissues were examined for the expression of KiSS-1 and KAI-1 protein by tissue microarray technique and immunohistochemistry (EnVision). The positive rate of KiSS-1 and KAI-1 was down-regulated (P < 0.05) in tumor tissues, compared with non-tumor tissues. The positive rate of KiSS-1 and KAI-1 were down-regulated (P < 0.01) in invasion tissues, compared with para-tumor tissues. Down-regulating expression levels of KiSS-1 and KAI-1 were significantly correlated with some malignant behavior of gallbladder carcinoma. The positive rate of KiSS-1 and KAI-1 were all negatively correlated with the Nevin staging of gallbladder carcinoma (P < 0.01). Moreover, a strong positive correlation was found between the positive expression of KiSS-1 and KAI-1 in gallbladder carcinoma (P < 0.001). It was indicated that KiSS-1 and KAI-1 were all associated with high metastasis potential of gallbladder carcinoma. KiSS-1 and/or KAI-1 may be important markers of reflecting invasive and metastatic potential and prognosis in gallbladder carcinoma, and may be the target genes to inhibit metastasis of gallbladder carcinoma. Detection of the expression of KiSS-1 and/or KAI-1 may have important clinical value for finding early-stage and evaluating the prognosis of gallbladder carcinoma.

Significance of researches of clinical staging of gallbladder carcinoma

Significance of researches of clinical staging of gallbladder carcinoma

MDCT in the Staging of Gallbladder Carcinoma

MDCT in the Staging of Gallbladder Carcinoma

MDCT in the Staging of Gallbladder Carcinoma

The purpose of our study was to determine the utility of dual-phase MDCT with 3D reconstruction in the staging and resectability of gallbladder carcinoma. Twenty-seven consecutive patients with suspected gallbladder carcinoma on clinical examination and routine sonography were prospectively analyzed with dual-phase MDCT. Of these patients, only 20 who underwent a laparotomy for extended cholecystectomy or a palliative surgery were included in the study. Three-dimensional volume-rendered reconstruction was used for evaluation of the vascular invasion and anatomy. The staging and resectability as determined on CT were compared with preoperative findings. On the basis of the CT findings, eight tumors were resectable and 12 were unresectable. On surgery, 11 tumors were found to be resectable and the remaining were unresectable. Overstaging by CT occurred in three patients due to overassessment of duodenal infiltration. CT had a sensitivity of 72.7%, a specificity of 100%, and an accuracy of 85% for determining resectability of gallbladder carcinoma. For the diagnosis of hepatic and vascular invasion by the tumor, there was 100% correlation between CT and surgery. Vascular variations were found in six of the 11 patients who underwent radical cholecystectomy. Dual-phase MDCT with 3D reconstruction is a comprehensive imaging technique for staging gallbladder carcinoma and determining the vascular road map before surgery.

Three‐dimensional helical computed tomography cholangiography with minimum intensity projection in gallbladder carcinoma patients with obstructive jaundice: Comparison with magnetic resonance cholangiography and percutaneous transhepatic cholangiography

Computed tomography (CT) is traditionally used for evaluation and staging of gallbladder carcinoma (GC). However, in the subgroup of patients with obstructive jaundice, magnetic resonance cholangiography (MRC) is generally required to assess the level of biliary obstruction. The present study was undertaken to evaluate the diagnostic potential of three-dimensional helical CT cholangiography (3-D CTC) with minimum intensity projection (minIP), to determine the presence and level of biliary obstruction. Twenty-five consecutive patients with proven GC, presenting with clinical and biochemical features of obstructive jaundice, over a 1-year period were included in the study. Dual phase helical CT data was obtained in the arterial and venous phases, respectively, after intravenous contrast injection using a pressure injector. Axial CT data (both arterial and venous phase) was studied for staging and resectability of tumor. Three-dimensional helical CT cholangiography using minIP obtained from the venous phase data set, was used to assess the level of biliary obstruction and isolation of hepatic segmental ducts. Three-dimensional helical CT cholangiography findings were compared with MRC and percutaneous transhepatic cholangiography (PTC) (gold standard). None of the patients were operated on as they were all considered inoperable on axial CT images due to extensive local disease or distant metastasis. In all patients, 3-D CTC demonstrated dilated intrahepatic ducts up to tertiary branch level. The 3-D CTC correctly diagnosed the level of biliary obstruction and demonstrated isolated segmental ducts in all patients and correlated well in all cases with MRC and PTC findings in this regard. However, the 3-D CTC did not add any additional information over the axial source images. Three-dimensional helical CT cholangiography with minIP can correctly determine the level of biliary obstruction in patients with GC and may be a strong competitor with MRC, because it gives equivalent information with regard to the level of ductal obstruction even while being a part of an overall comprehensive CT staging study. Even though 3-D CTC did not provide additional information on top of the source images, the referring physicians found them very useful for conceptualization of the 3-D biliary anatomy.