18-FDG PET-CT should be included in preoperative staging of gall bladder cancer

Goel, Sajal; Aggarwal, Abhishek; Iqbal, Asif; Gupta, Manoj; Rao, A. Muralikrishna; Singh, Sapna

doi:10.1016/j.ejso.2020.04.015

Cited by 22 publications

(11 citation statements)

References 15 publications

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“…Several studies have investigated GB cancer using F-18 FDG PET/CT. Most of them reported that F-18 FDG PET/CT plays a potential role in staging work-up and distinguishing the benign or malignant nature of the GB wall thickening [ 8 , 19 , 20 ]. A few studies evaluated the prognostic parameters using F-18 FDG PET/CT.…”

Section: Discussionmentioning

confidence: 99%

Clinical and metabolic parameters for predicting disease progression of gallbladder adenocarcinoma

Han

Jeong

Lim

2021

Nuclear Medicine Communications

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Objective This study aimed to identify reliable predictors of disease progression in patients with gallbladder (GB) adenocarcinoma. Patients and methods A total of 54 patients with GB adenocarcinoma underwent preoperative F-18 fluorodeoxyglucose (FDG) PET/CT. Age, sex, clinical stage, and pathologic differentiation were collected. Tumor size and PET parameters such as SUV max , SUV mean , SUV peak , metabolic tumor volume (MTV), and total lesion glycolysis were measured. Univariate and multivariate logistic regression analyses were performed to determine the utility of clinical values and PET parameters. Pearson bivariate correlation was used to evaluate the association between progression-free survival (PFS) and various parameters. Results No recurrence was found in 15 of 54 patients, while six showed recurrence and another 33 manifested disease progression. There were significant differences in size, stage, pathologic differentiation, and PET parameters between the groups with and without recurrence/progression. However, there was no difference in those parameters between the groups with recurrence and progression. The average PFS of the groups with no recurrence, recurrence, and progression groups was 33.1, 17.1, and 5.0 months, respectively. In univariate analysis, age, sex, clinical stage, pathologic differentiation, size, and PET parameters were correlated with PFS. In multivariate analysis, only clinical stage and MTV were statistically significant and MTV showed the highest odds ratio. Pearson correlation coefficients showed moderate negative correlations between PFS and clinical stage or MTV. Conclusion In GB adenocarcinoma, clinical stage and MTV are the most powerful parameters for predicting recurrence and disease progression. Based on clinical stage, MTV will represent a strong prognostic predictor.

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Section: Discussionmentioning

confidence: 99%

Clinical and metabolic parameters for predicting disease progression of gallbladder adenocarcinoma

Han

Jeong

Lim

2021

Nuclear Medicine Communications

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“…The tendency of GBC to have early systemic dissemination often rules out radical surgery. A recently published study from our centre showed that routine application of 18-FDG PET changed management in approximately one-fourth of all resectable primary GBC patients and in one-third of locally advanced cases due to detection of unsuspected distant metastasis[ 5 ]. Similarly, routine application of staging laparoscopy before surgical exploration prevented non-therapeutic laparotomy in 23% of overall GBC patients with higher yield in locally advanced cases[ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…CEA and CA19-9 were routinely measured in all cases. Since April 2015, all patients who had a resectable disease on CECT underwent an additional 18-FDG positron emission tomography (PET) scan to rule out distant metastasis as a part of the study to evaluate the role of PET scan in GBC[ 5 ]. All patients who presented with jaundice underwent magnetic resonance cholangiopancreatography to confirm the level of obstruction and biliary drainage procedure as indicated.…”

Section: Methodsmentioning

confidence: 99%

Multimodality management of gallbladder cancer can lead to a better outcome: Experience from a tertiary care oncology centre in North India

Goel¹,

Aggarwal²,

Iqbal³

et al. 2021

WJG

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BACKGROUND Surgical resection is a treatment of choice for gallbladder cancer (GBC) patients but only 10% of patients have a resectable disease at presentation. Even after surgical resection, overall survival (OS) has been poor due to high rates of recurrence. Combination of surgery and systemic therapy can improve outcomes in this aggressive disease. AIM To summarize our single-center experience with multimodality management of resectable GBC patients. METHODS Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database. Information extracted included demographics, operative and perioperative details, histopathology, neoadjuvant/adjuvant therapy, follow-up, and recurrence. To know the factors associated with recurrence and OS, univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables, respectively. Multivariate analysis was done using multiple regression analysis. RESULTS Of 274 patients with GBC taken up for surgical resection, 172 (62.7%) were female and the median age was 56 years. On exploration, 102 patients were found to have a metastatic or unresectable disease (distant metastasis in 66 and locally unresectable in 34). Of 172 patients who finally underwent surgery, 93 (54%) underwent wedge resection followed by anatomical segment IVb/V resection in 66 (38.4%) and modified extended right hepatectomy in 12 (7%) patients. The postoperative mortality at 90 d was 4.6%. During a median follow-up period of 20 mo, 71 (41.2%) patients developed recurrence. Estimated 1-, 3-, and 5-years OS rates were 86.5%, 56%, and 43.5%, respectively. Estimated 1- and 3-year disease free survival (DFS) rates were 75% and 49.2%, respectively. On multivariate analysis, inferior OS was seen with pT3/T4 tumor ( P = 0.0001), perineural invasion ( P = 0.0096), and R+ resection ( P = 0.0125). However, only pT3/T4 tumors were associated with a poor DFS ( P < 0.0001). CONCLUSION Multimodality treatment significantly improves the 5-year survival rate of patients with GBC up to 43%. R+ resection, higher T stage, and perineural invasion adversely affect the outcome and should be considered for systemic therapy in addition to surgery to optimize the outcomes. Multimodality treatment of GBC has potential to improve the survival of GBC patients.

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“…Furthermore, although PET has been reported to have low sensitivity of extrahepatic disease, particularly peritoneal carcinomatosis, it is still a useful adjunct to detect metastatic disease[ 38 ]. The recent study from Goel et al [ 39 ] showed that up to 23.4% patients had a change in the management following PET-CT and they suggested PET-CT should be included in preoperative work up.…”

Section: Clinical Presentation Of Gbcmentioning

confidence: 99%

Gallbladder cancer: Historical treatment and new management options

Okumura¹,

Gogna²,

Gachabayov³

et al. 2021

WJGO

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Gallbladder cancer is a rare, aggressive malignancy that has a poor overall prognosis. Effective treatment consists of early detection and surgical treatment. With the wide spread treatment of gallbladder disease with minimally invasive techniques, the rate of incidental gallbladder cancer has seen an equitable rise along with stage migration towards earlier disease. Although the treatment remains mostly surgical, newer modalities such as regional therapy as well as directed therapy based on molecular medicine has led to improved outcomes in patients with advanced disease. We aim to summarize the management of gallbladder cancer along with the newer developments in this formidable disease process.

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18-FDG PET-CT should be included in preoperative staging of gall bladder cancer

Cited by 22 publications

References 15 publications

Clinical and metabolic parameters for predicting disease progression of gallbladder adenocarcinoma

Clinical and metabolic parameters for predicting disease progression of gallbladder adenocarcinoma

Multimodality management of gallbladder cancer can lead to a better outcome: Experience from a tertiary care oncology centre in North India

Gallbladder cancer: Historical treatment and new management options

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