Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer

Abstract

The purpose of this study was to elucidate the roles of endoscopic ultrasonography (EUS), conventional US, CT, and MRI in differential diagnosis of gallbladder wall thickening. We scrutinized images for the presence of the multiple-layer patterns of the thickened gallbladder walls during preoperative images (EUS, n = 22; US, n = 23; CT, n = 20; MRI, n = 15) and retrospectively correlated them with surgical results in 25 patients. The pathological diagnoses included 7 gallbladder cancers, 9 cases of chronic cholecystitis, 5 cases of xanthogranulomatous cholecystitis, and 4 cases of adenomyomatosis. Multiple-layer patterns of gallbladder wall were observed in patients with inflammatory and benign diseases by US, EUS, CT, and MRI. This pattern was demonstrated by EUS more efficiently compared with other means of imaging. All subjects with loss of multiple layers were finally diagnosed by use of EUS as having gallbladder cancer at surgery. Loss of multiple-layer patterns of the gallbladder wall demonstrated by EUS was the most specific finding in diagnosing gallbladder cancer.

A Useful Approach to the Differential Diagnosis of Small Polypoid Lesions of the Gallbladder, Utilizing an Endoscopic Ultrasound Scoring System

“…The widespread use of conventional ultrasonography has led to identification of an increasing number of polypoid lesions of the gallbladder. However, it is still very difficult to make differential diagnoses of polypoid gallbladder lesions by ultrasound, CT, and magnetic resonance imaging [3,13,14]. Among the conventional ultrasound findings for polypoid gallbladder lesions, a solitary lesion, a diameter of greater than 10 mm, sessile appearance, hypoechoicity, and rapid growth all suggest neoplastic polyps, as noted in previous studies [3,5,19,20].…”

Xanthogranulomatous cholecystitis: report of a case and literature review on clinical differentiating factors from gallbladder carcinoma

“…Ultrasonography may reveal only non‐specific findings of calculi and a gallbladder with diffusely thickened wall. Loss of multiple‐layer patterns of the gallbladder wall demonstrated by endoscopic ultrasonography (EUS) was the most specific finding in differentiating gallbladder cancer from XGC and other inflammatory diseases 9 . If there is eccentric thickening of the wall, a gallbladder mass or an upper abdominal fluid collection suggesting complicated cholecystitis, the likelihood of underlying XGC is increased 4 .…”

EUS in Bile Duct, Gallbladder, and Ampullary Lesions

“…Because EUS is helpful in differentiating benign from malignant polyps, it can help to determine the optimal surgical approach: laparoscopy for benign polyps or early cancer, and open surgery for advanced cancer. 201 The accuracy of EUS in gallbladder cancer staging depends on the criteria chosen. The integrity of the wall layers at the base of a gallbladder polyp is the determinant (Fig.…”