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Ma W, Li W, Wang J, Wu R, Liu C, Feng F, Jiang X. The Clinical Role of Preoperative Serum CA19-9 and Carcinoembryonic Antigen (CEA) Levels in Evaluating the Resectability of Advanced Gallbladder Cancer. Med Sci Monit 2020; 26:e925017. [PMID: 32950997 PMCID: PMC7513615 DOI: 10.12659/msm.925017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The present study was designed to study the ability of preoperative serum concentrations of the tumor-associated biomarkers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and adjusted CA19-9 to assess the resectability of advanced gallbladder cancer (GBC). MATERIAL AND METHODS This retrospective study included patients with potentially resectable stage II-IV (AJCC 8th) GBC examined at our institution between January 2012 and December 2016. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value and optimal cut-off point of tumor-associated biomarkers for curative resection. RESULTS Pathological examination of the 309 patients included in this study found that 169 (54.7%) underwent R0 (curative) resection, whereas 121 (39.2%) underwent R1/2 (non-curative) resection, and 19 (6.1%) were unresectable. The mean serum concentrations of CEA, CA19-9 and adjusted CA19-9 were significantly lower in patients who underwent R0 resection than in the other groups. ROC curve analysis showed that adjusted CA19-9 concentration was better able to predict resectability (area under the curve, 0.774; 95% confidence interval, 0.722-0.826; P<0.001) than total bilirubin, CEA, and CA19-9 concentrations. The optimal cut-off for adjusted CA19-9 concentration was 47.63 U/mL, which had a sensitivity of 69.82%, a specificity of 75%, a positive predictive value of 77.12% and a negative predictive value of 67.31%. CONCLUSIONS Adjusted CA19-9 concentration is an easily calculated parameter superior to CA19-9 and CEA concentrations in predicting the resectability of advanced gallbladder cancer.
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Affiliation(s)
- Wencong Ma
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Wei Li
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Jinghan Wang
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Rui Wu
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Chen Liu
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Feiling Feng
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Xiaoqing Jiang
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
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Raj G, Singh B, Raj R, Singh R. Lymph Nodal Metastatic Pattern in Carcinoma Gallbladder with Multidetector Computed Tomography: An Institutional Experience. ASIAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.1055/s-0040-1714306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective This work aimed to study the distribution of lymph nodal metastatic pattern in carcinoma gallbladder with multidetector computed tomography (CT).
Materials and Methods A retrospective observational study was conducted including 80 patients with carcinoma gallbladder who underwent triple-phase CT angiography or single-phase contrast-enhanced CT scan of the abdomen between January 2019 and November 2019.
Results In our study, 75 (93.7%) out of 80 cases showed metastasis to lymph nodes, with distribution as follows: periportal (69), peripancreatic (62), and aortocaval (47). The most common involved combination included all three lymph nodal groups (periportal, peripancreatic, and aortocaval), involving 40 (50%) cases. The combination of only periportal and peripancreatic lymph nodes was seen in 17 (21%) cases. Isolated periportal lymph nodes were seen in eight cases (10%) cases. The combination of only periportal and aortocaval lymph nodes was seen in four (5%) cases. Isolated peripancreatic lymph nodes were seen in three (3.7%) cases. The combination of periportal and aortocaval was seen in four (5%) cases followed by peripancreatic and aortocaval lymph nodes that was seen in two (2.5%) cases. Isolated aortocaval lymph nodes were seen in one (1.2%) case.
Conclusion Periportal lymph nodes were the single most commonly involved station followed by peripancreatic and aortocaval lymph nodes. The combination of periportal, peripancreatic, and aortocaval lymph nodes was seen most commonly. The second most commonly involved combination was found to be periportal and peripancreatic lymph nodes followed by isolated periportal lymph nodes.
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Affiliation(s)
- Gaurav Raj
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Bhanupriya Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Richa Raj
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ragini Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Gamboa AC, Maithel SK. The Landmark Series: Gallbladder Cancer. Ann Surg Oncol 2020; 27:2846-2858. [PMID: 32474816 DOI: 10.1245/s10434-020-08654-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Indexed: 12/13/2022]
Abstract
Given the rarity of gallbladder carcinoma, level I evidence to guide the multimodal treatment of this disease is lacking. Since 2010, four randomized phase III clinical trials including ABC-02, PRODIGE-12/ACCORD-18, BILCAP, and BCAT, and a single-arm phase II trial (SWOG0809) have been reported on the use of adjuvant strategies for biliary malignancies. These trials have led to the recommendation that patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy and those with R1 margins could be considered for chemoradiotherapy. Because there is no level I evidence to guide neoadjuvant therapy or surgical management, current consensus is based on strong retrospective data. The following review summarizes available trials and highlights the best available evidence that form the basis of consensus statements for the multimodal management of gallbladder carcinoma.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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Liu F, Wang JK, Ma WJ, Yang Q, Hu HJ, Li FY. Clinical value of preoperative CA19-9 levels in evaluating resectability of gallbladder carcinoma. ANZ J Surg 2018; 89:E76-E80. [PMID: 30306702 DOI: 10.1111/ans.14893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/29/2018] [Accepted: 09/01/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Fei Liu
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Jun-Ke Wang
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Wen-Jie Ma
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Qin Yang
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Hai-Jie Hu
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
| | - Fu-Yu Li
- Department of Biliary Surgery; West China Hospital of Sichuan University; Chengdu China
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5
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Loozen CS, Oor JE, van Ramshorst B, van Santvoort HC, Boerma D. Conservative treatment of acute cholecystitis: a systematic review and pooled analysis. Surg Endosc 2016; 31:504-515. [PMID: 27317033 DOI: 10.1007/s00464-016-5011-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/27/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND In medical practice, the tendency to remove an inflamed gallbladder is deeply rooted. Cholecystectomy, however, is associated with relatively high complication rates, and therefore the decision whether or not to perform surgery should be well considered. For some patients, the surgical risk-benefit profile may favour conservative treatment. The objective of this study was to examine the short- and long-term outcome of conservative treatment of patients with acute calculous cholecystitis. METHODS A systematic search of MEDLINE, Embase and Cochrane Library databases was performed. Prospective studies reporting on the success rate of conservative treatment (i.e. non-invasive treatment) of acute cholecystitis during index admission were included, as well as prospective and retrospective studies reporting on the recurrence rate of gallstone-related disease during long-term follow-up (i.e. ≥12 months) after initial non-surgical management. Study selection was undertaken independently by two reviewers using predefined criteria. The risk of bias was assessed. The pooled success and mortality rate during index admission and the pooled recurrence rate of gallstone-related disease during long-term follow-up were calculated using a random-effects model. RESULTS A total of 1841 patients were included in 10 randomized controlled trials and 14 non-randomized studies. Conservative treatment during index admission was successful in 87 % of patients with acute calculous cholecystitis and in 96 % of patients with mild disease. In the long term, 22 % of the patients developed recurrent gallstone-related disease. Pooled analysis showed a success rate of 86 % (95 % CI 0.8-0.9), a mortality rate of 0.5 % (95 % CI 0.001-0.009) and a recurrence rate of 20 % (95 % CI 0.1-0.3). DISCUSSION Conservative treatment of acute calculous cholecystitis during index admission seems feasible and safe, especially in patients with mild disease. During long-term follow-up, less than a quarter of the patients appear to develop recurrent gallstone-related disease, although this outcome is based on limited data.
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Affiliation(s)
- Charlotte S Loozen
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands.
| | - Jelmer E Oor
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands
| | - Bert van Ramshorst
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands
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6
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Tubay M, Zelasko S. Multimodality Imaging of the Gallbladder: Spectrum of Pathology and Associated Imaging Findings. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0148-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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7
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Esnaola NF, Meyer JE, Karachristos A, Maranki JL, Camp ER, Denlinger CS. Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma. Cancer 2016; 122:1349-69. [PMID: 26799932 DOI: 10.1002/cncr.29692] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinomas are rare biliary tract tumors that are often challenging to diagnose and treat. Cholangiocarcinomas are generally categorized as intrahepatic or extrahepatic depending on their anatomic location. The majority of patients with cholangiocarcinoma do not have any of the known or suspected risk factors and present with advanced disease. The optimal evaluation and management of patients with cholangiocarcinoma requires thoughtful integration of clinical information, imaging studies, cytology and/or histology, as well as prompt multidisciplinary evaluation. The current review focuses on recent advances in the diagnosis and treatment of patients with cholangiocarcinoma and, in particular, on the role of endoscopy, surgery, transplantation, radiotherapy, systemic therapy, and liver-directed therapies in the curative or palliative treatment of these individuals. Cancer 2016;122:1349-1369. © 2016 American Cancer Society.
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Affiliation(s)
- Nestor F Esnaola
- Department of Surgery, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
| | - Andreas Karachristos
- Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer L Maranki
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania
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Dwivedi AND, Jain S, Dixit R. Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread. World J Clin Cases 2015; 3:231-244. [PMID: 25789296 PMCID: PMC4360495 DOI: 10.12998/wjcc.v3.i3.231] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/25/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
The most common malignancy of biliary tract is gallbladder cancer (GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a very poor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is based on the gender, geography and ethnicity which suggest that both genetic and environmental factors can cause GBC. The major route of spread of gallbladder cancer (GC) is loco-regional rather than distant. It spreads by lymphatic, vascular, neural, intraperitoneal, and intraductal routes. Sonography is usually the most common imaging test to evaluate symptoms of biliary tract disease including suspected GC. With recent advances in imaging modalities like multi-detector computed tomography (CT) scanners, magnetic resonance imaging-positron emission tomography/CT diagnosis of gallbladder cancer has improved. Studies have also targeted molecular and genetic pathways. Treatment options have included extended and radical surgeries and adjuvant chemotherapy. This review article deals in detail with important aspects of carcinoma gallbladder and its manifestations and challenges. Role of various imaging modalities in characterization and accurate staging has been discussed. The loco-regional spread of this aggressive malignancy is dealt explicitly.
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Glockner JF, Lee CU. Balanced steady state-free precession (b-SSFP) imaging for MRCP: techniques and applications. ACTA ACUST UNITED AC 2014; 39:1309-22. [DOI: 10.1007/s00261-014-0153-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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10
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Abstract
Advances in biliary imaging have improved making accurate diagnoses of the presence and causes of biliary obstruction. Abdominal ultrasound is a useful screening tool because it is highly specific for choledocholithiasis. New developments in CT and MRI have also been useful in the diagnosis of biliary disease. Although diagnosis of biliary disease can be achieved in a noninvasive manner, there are limitations to modern MRI and CT cholangiographic techniques; their use may not be necessary or cost effective. MRI and CT imaging of the biliary tract provides opportunities for less-invasive diagnostic techniques but should be used judiciously before interventional endoscopy.
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Affiliation(s)
- Linda Ann Hou
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Zhuang PY, Tang ZH, Liu YB, Quan ZW, Zhang YJ. Diagnostic and prognostic role of laparoscopic staging for gallbladder carcinoma. Dig Surg 2012; 29:367-73. [PMID: 23108362 DOI: 10.1159/000343926] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/30/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic and prognostic role of staging laparoscopy in gallbladder carcinoma (GBC). METHODS From January 2007 through December 2010, 79 GBC patients without evidence of metastatic disease on preoperative imaging underwent staging laparoscopy. Peritoneal and liver metastases were assessed by a single surgeon in a systematic manner. Resection rate, safety, and survival analysis were compared between the laparoscopy group and no laparoscopy group. RESULTS Disseminated disease was detected in 27 patients and no further surgery was performed; the overall accuracy for detecting unresectable disease was 67.5% (27/40), with 39 (75%) and 27 (51.9%) receiving resection and curative resection. In 203 GBC patients undergoing laparotomy, 90 (44.3%) and 53 (26.1%) patients received resection and curative resection; therefore, the resection rate and curative resection rate were significantly much higher in the laparoscopy group (p < 0.000). CONCLUSIONS Staging laparoscopy in GBC is sensitive in detecting disseminated disease and increases the curative resection rate, shortens the recovery time, and has no negative implications on overall survival; therefore, we suggest the routine use of staging laparoscopy in patients with GBC without evidence of disseminated disease on preoperative imaging.
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Affiliation(s)
- Peng-Yuan Zhuang
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
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12
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Andrén-Sandberg A. Diagnosis and management of gallbladder cancer. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:293-9. [PMID: 22866265 PMCID: PMC3409652 DOI: 10.4103/1947-2714.98586] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gallbladder cancer (GBC) is a rather uncommon disease, but at the time when it gives symptoms it has usually reached no longer curable stage. Therefore, all attempts must be made to make the diagnosis earlier to have better opportunity for cure. The author searched PubMed, and reviewed literatures on diagnoses and treatment of GBC.
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Affiliation(s)
- Ake Andrén-Sandberg
- Department of Surgery, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden
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13
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Liu YF, Zhao R, Guo S, Wang XQ, Lian PL, Chen YG, Xu KS. Expression and Clinical Significance of Hepatoma-Derived Growth Factor as a Prognostic Factor in Human Hilar Cholangiocarcinoma. Ann Surg Oncol 2010; 18:872-9. [DOI: 10.1245/s10434-010-1303-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Indexed: 12/17/2022]
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Zhang XM, Mitchell DG, Byun JH, Verma SK, Bergin D, Witkiewicz A. Gallbladder abnormalities in carcinoma of pancreatic head: findings on MR imaging. ACTA ACUST UNITED AC 2009; 34:507-13. [PMID: 18546035 DOI: 10.1007/s00261-008-9422-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Our objective is to study the gallbladder abnormalities on MR images associated with carcinoma of the pancreatic head. METHODS Thirty-six patients who had surgical resection of pancreatic head carcinoma were retrospectively analyzed regarding the appearance of the tumor and gallbladder on MR imaging performed within one month before surgery. The changes of the gallbladder wall, and the dimension of the gallbladder, cystic duct, pericholecystic region, and common bile duct (CBD) on MR imaging were noted. RESULTS About 92% (33/36) of patients had at least one gallbladder abnormality on MR imaging, including thickened gallbladder wall (58%), gallbladder wall striation (19%), gallbladder wall severe enhancement (44%), enlarged gallbladder (33%), gallbladder stone (19%), dilatation of cystic duct (67%), focally increased liver parenchymal enhancement adjacent to the gallbladder (19%), and pericholecystic fluid (11%). 64% of patients had dilated CBD. The diameter of the cystic duct was correlated with those of the CBD (r = 0.45, P < 0.01) and gallbladder (r = 0.56, P < 0.0001). Enlarged gallbladder, dilatation of the cystic duct, and CBD were correlated with chronic cholecystitis. CONCLUSION Most patients with pancreatic head carcinoma show gallbladder abnormalities on MR imaging. Cystic duct dilatation follows CBD dilatation and is the primary cause for dilated gallbladder and chronic cholecystitis in carcinoma of pancreatic head.
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Affiliation(s)
- Xiao Ming Zhang
- Department of Radiology, Thomas Jefferson University Hospital, 1094 Main Bulding, Philadelphia, PA 19107, USA.
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15
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Aljiffry M, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009. World J Gastroenterol 2009; 15:4240-62. [PMID: 19750567 PMCID: PMC2744180 DOI: 10.3748/wjg.15.4240] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Several advances in diagnosis, treatment and palliation of cholangiocarcinoma (CC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. CC is a relatively rare tumor and the main risk factors are: chronic inflammation, genetic predisposition and congenital abnormalities of the biliary tree. While the incidence of intra-hepatic CC is increasing, the incidence of extra-hepatic CC is trending down. The only curative treatment for CC is surgical resection with negative margins. Liver transplantation has been proposed only for selected patients with hilar CC that cannot be resected who have no metastatic disease after a period of neoadjuvant chemo-radiation therapy. Magnetic resonance imaging/magnetic resonance cholangiopancreatography, positron emission tomography scan, endoscopic ultrasound and computed tomography scans are the most frequently used modalities for diagnosis and tumor staging. Adjuvant therapy, palliative chemotherapy and radiotherapy have been relatively ineffective for inoperable CC. For most of these patients biliary stenting provides effective palliation. Photodynamic therapy is an emerging palliative treatment that seems to provide pain relief, improve biliary patency and increase survival. The clinical utility of other emerging therapies such as transarterial chemoembolization, hepatic arterial chemoinfusion and high intensity intraductal ultrasound needs further study.
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Hilar cholangiocarcinoma: role of preoperative imaging with sonography, MDCT, MRI, and direct cholangiography. AJR Am J Roentgenol 2008; 191:1448-57. [PMID: 18941084 DOI: 10.2214/ajr.07.3992] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the roles of sonography, MDCT, MRI, and direct cholangiography in the evaluation of hilar cholangiocarcinoma. CONCLUSION Hilar cholangiocarcinoma is a primary malignant tumor typically located at the confluence of the right and left ducts within the porta hepatis. Staging of hilar cholangiocarcinoma with various imaging techniques is crucial for management, and a comprehensive approach is needed for accurate preoperative assessment.
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Vialle R, Velasco S, Milin S, Bricot V, Richer JP, Levillain PM, Tasu JP. [Imaging in the diagnosis and the staging of gallbladder tumors]. ACTA ACUST UNITED AC 2008; 32:931-41. [PMID: 18954953 DOI: 10.1016/j.gcb.2008.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 08/10/2008] [Accepted: 09/12/2008] [Indexed: 02/07/2023]
Abstract
Most of gallbladder tumors are benign. Adenoma, cholesterol polyps, or adenomyomatosis are most frequently typical on ultrasonographic images. All symptomatic lesions must be considered as indications for surgery. It may be difficult to identify precancerous or malignant lesion. Polyps over 1cm are indication for preventive cholecystectomy. In case of suspicious polyp or suspicious wall thickening, endoscopic ultrasonography can be helpful to evaluate local tumoral spread and eliminate differential diagnosis. Unfortunately, diagnosis of gallbladder cancer is often late, when surgical resection can't be curative. Computed tomography and magnetic resonance imaging examinations are then useful for local and metastatic staging.
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Affiliation(s)
- R Vialle
- Service de radiologie, CHU de Poitiers, BP 577, 86021 Poitiers, France.
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Xu LN, Zou SQ. A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases. World J Gastroenterol 2007; 13:1857-60; discussion 1860-1. [PMID: 17465481 PMCID: PMC4149967 DOI: 10.3748/wjg.v13.i12.1857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the clinicopathological characteristics of unsuspected gallbladder carcinoma (UGC).
METHODS: We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma (PDGC).
RESULTS: The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC (χ2 = 13.53, P < 0.01). The infection rate of hepatitis B virus was 21.74% (5/23) in UGC and 30.30% (10/33) in PDGC. Nine (39.13%) of 23 patients with UGC and 8/33 (24.24) PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% (13/23) in the patients with UGC and 42.42% (14/33) in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and II UGC was significantly higher than that of PDGC (χ2 = 4.44, P < 0.05 and χ2 = 4.96, P < 0.05) while that of Nevin stage V UGC was significantly lower than that of PDGC (χ2 = 7.59, P < 0.01). According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC (χ2 = 4.16, P < 0.05), and that of poorly-differentiated UGC was significantly lower than that of PDGC (χ2 = 4.48, P < 0.05).
CONCLUSION: There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.
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Affiliation(s)
- Li-Ning Xu
- Department of Hepatobiliary Surgery of PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
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