Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis?

Hijioka, Susumu; Mekky, Mohamed A.; Bhatia, Vikram; Sawaki, Akira; Mizuno, Nobumasa; Hara, Kazuo; Hosoda, Waki; Shimizu, Yasuhiro; Tamada, Kiichi; Niwa, Yasumasa; Yamao, Kenji

doi:10.1016/j.gie.2010.05.022

Cited by 68 publications

(52 citation statements)

References 21 publications

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“…Nevertheless, it may be difficult to distinguish them. EUS-guided FNAC has been suggested preoperatively by Hijioka et al [17]. Based on presumptive imaging diagnosis of XGC along with the above peroperative findings, open cholecystectomy and frozen section was performed in 10 patients in our series thus avoiding mutilating radical surgery.…”

Section: Discussionmentioning

confidence: 95%

Xanthogranulomatous Cholecystitis: Catching the Culprit – Clinical and Imaging Analysis

Jain

Saluja²,

Sharma³

et al. 2012

Dig Surg

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Background: Radiological and intraoperative findings of xanthogranulomatous cholecystitis (XGC) mimic carcinoma gallbladder (CaGB) leading to extended surgical resections and increased morbidity. We reviewed the clinical and CECT findings of histopathologically proven XGC and compared them with those of CaGB. Methods: The clinical and CECT findings from 22 patients with XGC were compared with 15 patients with CaGB manifesting as diffuse wall thickening. Results: GB wall thickness was similar in both groups (XGC 12.4 ± 3 mm, CaGB 13.9 ± 6.5 mm; p = 0.61). Intramural hypoattenuating nodules occupying >60% of the GB wall were suggestive of XGC, while the absence of nodules suggested CaGB (p = 0.017). The mucosal lining was intact and enhancing in XGC (20/22) and disrupted in CaGB (10/15; p = 0.001). Among adjacent organ infiltration, bile duct invasion resulting in obstruction was a significant finding in patients with CaGB (p = 0.04). Among XGC patients, 11 patients underwent radical cholecystectomy, 10 had open cholecystectomy and frozen section and 1 underwent bypass. Conclusions: Though there is an overlap between XGC and CaGB, the presence of intramural hypoattenuating nodules occupying >60% of the diffusely thickened GB wall with intact mucosal line and the absence of obstructive features suggest XGC. In the presence of such imaging features, frozen biopsy should be done before proceeding with mutilating radical surgery.

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Section: Discussionmentioning

confidence: 95%

Xanthogranulomatous Cholecystitis: Catching the Culprit – Clinical and Imaging Analysis

Jain

Saluja²,

Sharma³

et al. 2012

Dig Surg

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“…The accuracy of EUS-FNA for detecting malignancy and for the final diagnosis is approximately 93% and 80%, respectively [13, 14]. Sampling errors in the form of samples from nonrepresentative areas along with a confounding factor of coexistence of XGC and GBC limit the widespread applicability of EUS-FNA in XGC [13, 14]. Intraoperative frozen section examination is an efficient method for exclusion of GBC.…”

Section: Discussionmentioning

confidence: 99%

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?

Rammohan

Cherukuri

Sathyanesan

et al. 2014

Gastroenterology Research and Practice

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Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC. Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC. Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases. Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases.

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“…The diagnostic accuracy of EUS-FNA to correctly distinguish between benign and malignant masses in their study was 93.3 % with a sensitivity and specificity of 90 and 100 %, respectively. 1 Only one EUS-FNA result was a false negative because of insufficient sampling from unresectable GB carcinoma, and none of the results were false positive. In another study of 83 cases, diagnostic sensitivity of EUS-FNA was 96 % with no procedure-related complications.…”

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confidence: 92%

“…To overcome the limitations of percutaneous FNA and, at the same time, in order to achieve tissue diagnosis, EUS-FNA has been increasingly used in suspicious cases to differentiate gall bladder cancer (GBC) from XGC. In a study of 51 cases of gall bladder masses by Hijioka et al, 1 they found that EUS findings of disrupted gall bladder mucosal lining and/or regional lymph nodes are highly suggestive of gall bladder cancer and uncommon in XGC. EUS-FNA of these gall bladder masses or regional lymph nodes is very useful in making definitive diagnosis.…”

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confidence: 99%

Letter to Editor

Gupta

2014

Journal of Gastrointestinal Surgery

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Sir, I read with interest the article entitled 'Mass-forming xanthogranulomatous cholecystitis masquerading as gallbladder cancer'. The authors have proposed a very practical algor i t h m f o r t h e m a n a g e m e n t o f m a s s -f o r m i n g xanthogranulomatous cholecystitis (XGC), but I would like to highlight the evolving role of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (FNA) in such cases of gall bladder masses. To overcome the limitations of percutaneous FNA and, at the same time, in order to achieve tissue diagnosis, EUS-FNA has been increasingly used in suspicious cases to differentiate gall bladder cancer (GBC) from XGC. In a study of 51 cases of gall bladder masses by Hijioka et al., 1 they found that EUS findings of disrupted gall bladder mucosal lining and/or regional lymph nodes are highly suggestive of gall bladder cancer and uncommon in XGC. EUS-FNA of these gall bladder masses or regional lymph nodes is very useful in making definitive diagnosis. The diagnostic accuracy of EUS-FNA to correctly distinguish between benign and malignant masses in their study was 93.3 % with a sensitivity and specificity of 90 and 100 %, respectively. 1 Only one EUS-FNA result was a false negative because of insufficient sampling from unresectable GB carcinoma, and none of the results were false positive. In another study of 83 cases, diagnostic sensitivity of EUS-FNA was 96 % with no procedure-related complications. 2 A recent systematic review and meta-analysis of nine studies with 284 patients of bile duct and gall bladder masses has revealed that pooled sensitivity and specificity of EUS-FNA is 84 and 100 %, respectively, and concluded that it is a safe and accurate tool for diagnosis. 3 In a study of six patients by Varadarajulu et al.,4 where CT detected definitive gall bladder mass only in one patient, EUS-FNA correctly diagnosed the masses in all the six cases. This suggests that EUS-FNA is more sensitive and accurate than CT and should be used in the case of high clinical suspicion with normal or inconclusive CT before undertaking surgery. References

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Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis?

Cited by 68 publications

References 21 publications

Xanthogranulomatous Cholecystitis: Catching the Culprit – Clinical and Imaging Analysis

Xanthogranulomatous Cholecystitis: Catching the Culprit – Clinical and Imaging Analysis

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?

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