Early Diagnosis of Gallbladder Carcinoma: An Algorithm Approach

Abstract

Gall bladder carcinoma is the most common biliary tract cancer. Delayed presentation and early spread of tumor make it one of the lethal tumors with poor prognosis. Considering that simple cholecystectomy for T1 disease could offer a potential cure, it is increasingly needed to identify it at early stages. Identification of high-risk cases and offering prophylactic cholecystectomy can decrease the incidence of gallbladder carcinoma. With advances in diagnostic tools like contrast-enhanced endoscopic ultrasound, elastography, multidetctor CT, MRI, and PET scan, we can potentially diagnose gallbladder carcinoma at early stages. This paper reviews the various diagnostic modalities available and an algorithmic approach to early diagnosis of gallbladder carcinoma.

Validation of the 8th Edition of the American Joint Committee on Cancer Staging System for Gallbladder Cancer and Implications for the Follow-up of Patients without Node Dissection

“…Gallbladder cancer is the most common malignancy of the biliary tract with a wide range of geographical variability and prevalence. Its prevalence is reportedly higher in Chile, Poland, India, Pakistan, Ecuador, Japan, and Korea [1], but lower in the Western countries, including the United States, United Kingdom, Australia, and New Zealand [2]. Gallbladder cancers are detected either incidentally or by symptom occurrence.…”

Endoscopic Ultrasonography (EUS) and Gallbladder

“…In addition to this, gallbladder carcinoma is not sensitive to radiotherapy and chemotherapy. All of these characteristics make gallbladder carcinoma as a highly lethal tumor with a five-year survival rate of less than 5% [16,21]. Many of the signs and symptoms of gallbladder carcinoma are nonspecific, so it is more likely to be diagnosed at an advanced stage in patients and is associated with a high mortality rate.…”

“…In addition, there has been interest in using EUS for preoperative staging of gallbladder carcinoma because of this procedure allow detailed visualization of the layers of the gallbladder wall [4,16]. This procedure is more sensitive than transabdominal US and has the added benefit of determining depth of invasion, extent of local disease, and nodal disease.…”

“…Moreover, diagnostic accuracy of EUS has been shown for T-stage: Tis-stage 100%, T1-stage 75.6%, T2-stage 85.3%, and T3,4-stage 92.7%. EUS also adds the possibility of fine needle aspiration (FNA) for tissue diagnosis of the primary as well as lymph nodes, where diagnostic accuracy approaches 100% [16,21].…”

“…Current recommendations for the management of gallbladder polyps are based largely on polyp size. Gallbladder polyps larger than 10 mm in diameter, particularly among patients more than 50 years of age, are generally indications for cholecystectomy because of the risk of malignancy [4,14,16].…”