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

Ramos-Font, C.; Gómez-Río, Manuel; Rodrı́guez-Fernández, Antonio; Jiménez-Heffernan, Amelia; Sánchez, R. Sánchez; Elvira, J.M. Llamas

doi:10.1002/jso.23476

Cited by 56 publications

(37 citation statements)

References 24 publications

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“…In one study of 108 patients undergoing PET before reresection, there was useful signal take‐up in patients with disseminated disease, particularly in those with T2 status. Another study found altered management in 22 per cent of patients based on PET results, with accuracy reaching 100 per cent for disseminated disease when used in a restaging setting. Although data are currently based on few series of incidental gallbladder cancer, these suggest that PET–CT has a role before reresection in any T1b cancer and above for detection of disseminated disease, and for ruling out local residual disease in T1b cancers.…”

Section: Resultsmentioning

confidence: 99%

“…Another study found altered management in 22 per cent of patients based on PET results, with accuracy reaching 100 per cent for disseminated disease when used in a restaging setting. Although data are currently based on few series of incidental gallbladder cancer, these suggest that PET–CT has a role before reresection in any T1b cancer and above for detection of disseminated disease, and for ruling out local residual disease in T1b cancers. One study advised against undertaking redo surgery in patients with T1b cancers if PET–CT findings were negative, as the likelihood of finding residual disease was very low.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2018

British Journal of Surgery

106

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Background Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. Methods A systematic PubMed search of the English literature to May 2018 was conducted. Results The search identified 12 systematic reviews and meta‐analyses, in addition to several consensus reports, multi‐institutional series and national audits. Some 0·25–0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one‐third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5‐year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross‐sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET‐avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port‐site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Conclusion Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2018

British Journal of Surgery

106

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“…Data from high‐volume centres demonstrating that up to 26% of GBC patients will have axial LN involvement (aortocaval/coeliac) that would negate any benefit of radical surgery indicate that aortocaval LN sampling should be performed routinely at the initiation of the operation . Although periportal regional LN (N1) involvement does not contraindicate radical resection, it is a very poor prognostic indicator, and therefore the presence of an institutional neoadjuvant therapy protocol for locally advanced GBC may indicate that pathologic confirmation of regional disease should discontinue the immediate plan for up‐front resection in favour of the prospective evaluation of pre‐resection chemotherapy and/or chemoradiotherapies …”

Section: Evaluation and Management Of A Gallbladder Massmentioning

confidence: 99%

“…32,33 Although periportal regional LN (N1) involvement does not contraindicate radical resection, it is a very poor prognostic indicator, and therefore the presence of an institutional neoadjuvant therapy protocol for locally advanced GBC may indicate that pathologic confirmation of regional disease should discontinue the immediate plan for up-front resection in favour of the prospective evaluation of pre-resection chemotherapy and/or chemoradiotherapies. 34 Laparoscopic and open approaches to definitive resection Minimally invasive resection of intact GBC has been performed at specialized expert centres. These centres have reported safety and feasibility outcome data for T1b, T2 and even T3 tumours that rival the outcomes of open surgery, 35 but no randomized studies have objectively compared the minimally invasive and open surgery approaches.…”

Section: Intraoperative Ln Evaluationmentioning

confidence: 99%

Gallbladder Cancer: expert consensus statement

Aloia

Jarufe

Javle

et al. 2015

HPB

369

319

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An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled. Provided the patient is medically fit for surgery, data support the resection of all gallbladder polyps of >1.0 cm in diameter and those with imaging evidence of vascular stalks. The minimum staging evaluation of patients with suspected or proven gallbladder cancer includes contrasted cross-sectional imaging and diagnostic laparoscopy. Adequate lymphadenectomy includes assessment of any suspicious regional nodes, evaluation of the aortocaval nodal basin, and a goal recovery of at least six nodes. Patients with confirmed metastases to N2 nodal stations do not benefit from radical resection and should receive systemic and/or palliative treatments. Primary resection of patients with early T-stage (T1b-2) disease should include en bloc resection of adjacent liver parenchyma. Patients with T1b, T2 or T3 disease that is incidentally identified in a cholecystectomy specimen should undergo re-resection unless this is contraindicated by advanced disease or poor performance status. Re-resection should include complete portal lymphadenectomy and bile duct resection only when needed to achieve a negative margin (R0) resection. Patients with preoperatively staged T3 or T4 N1 disease should be considered for clinical trials of neoadjuvant chemotherapy. Following R0 resection of T2-4 disease in N1 gallbladder cancer, patients should be considered for adjuvant systemic chemotherapy and/or chemoradiotherapy.

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“…Though ultrasonography (USG) is most widely used initial screening as well diagnostic tool, it lacks sensitivity and specificity for early cancer. Other preferred investigations are endoscopic ultrasound (EUS), computed tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP) and fluorodeoxyglucose positron emission tomography (FDG-PET) [9]. Although there is currently no single tumor marker helping clinch diagnosis, promising one include cancer antigen (CA) 242, CA-125, and CA-19-9.…”

Section: Introductionmentioning

confidence: 99%