Diagnostic utility of ultrasound-guided fine-needle aspiration cytology in gall bladder lesions: an experience from a tertiary care cancer center in Eastern India

Abstract

Introduction: Gallbladder cancer (GBC) is the most common malignancy, representing 80–95% of biliary tract cancers. Although ultrasonography-guided fine-needle aspiration cytology (USG-FNAC) has emerged as an effective diagnostic the tool for the precise diagnosis of gallbladder lesions, data on its diagnostic utility and cytomorphological categorization of gallbladder lesions are lacking. Aims: To study the diagnostic utility of USG-FNAC in gallbladder lesions. Materials and Methods: This study was the conducted prospectively on patients who came with clinical and radiological evidence of gallbladder space-occupying lesion and then advised to USG-FNAC over 2 years and 6 months from January 2018 to June 2020. Results: A total of 314 cases were included. The mean age was 56 years, with a range of 17–88 years. Women predominated over men (Male:Female = 1:2.3). Primary adenocarcinoma of the gallbladder was most common. On cyto-histological correlation, the sensitivity, specificity, and diagnostic accuracy of USG-FNAC of gallbladder lesions were found to be 98.82, 87.23, and 96.3%, respectively. Conclusion: The USG-FNAC of gallbladder lesion was found to be an easy, quick, cost-effective, and presumptive diagnostic procedure. It should be opted as an initial preoperative diagnostic modality in high incidence areas to avoid inappropriate management with unnecessary morbidity and cost. Moreover, a close cytological examination of the architectural pattern and the cytomorphological features would help in the sub-typing and prognosticating the tumor.

Cytological evaluation of spectrum of Hepatobiliary and Pancreatic mass lesions

“…The most frequent GB lesions were the malignant cases which constituted 33 cases of Adenocarcinoma making it the most common, followed by 3 cases of Cholangiocarcinoma. Similar findings were also seen in studies by Selhi et al, 22 Rout et al 23 and Rahul Ranjan et al 1 Among these, there were 2 cases of Mucinous Adneocarcinoma, the smears of which showed clusters and acini of tumor cells having high N:C ratio, enlarged hyperchromatic and pleomorphic nuclei and moderate to scant amount of cytoplasm along with abundance of extracellular mucin. These findings are in concordance with a study by Singh et al 24 where it was also mentioned that the mucinous adenocarcinoma account for 2.5% of all carcinoma in gall bladder meeting the criteria of more than 50% extracellular mucin (WHO).…”

“…25 One case of Papillary Adenocarcinoma of Gall bladder was also reported, cytological smears showing presence of true papillae with fibrovascular cores with cytological atypical and occasional mitotic figures. This subtype os associated with good prognosis as mentioned by Chandra et al and Rout et al 23,26 In our study, there were also 3 cases of Cholangiocarcinoma. Smears from these patients showed clusters of tumor cells having enlarged pleomorphic nuclei, prominent nucleoli and occasionally vacuolated cytoplasm.…”