Role of Endoscopic Ultrasound in Diagnosis and Staging of Carcinoma Gall Bladder

Ranjith Kumar Ramasamy, MS, Thakur D Yadav, MS, Vikas Gupta, MCH, Rakesh Kochhar, DM, Saroj K Sinha, DM, Ashim Das, MD. PGIMER

INTRODUCTION: Staging is the strongest prognostic factor for Gallbladder carcinoma. Traditionally Contrast enhanced computed tomography (CECT) is the gold standard test to assess the resectability. But the role of CECT in picking up the tumour spread in the hepatoduodenal ligament has been limited. Role of endoscopic ultrasound in the evaluation of periampullary tumour, carcinoma  head of pancreas, lower CBD carcinoma were well established. Very limited experience has been reported in the literature regarding the role of endoscopic ultrasound in carcinoma gallbladder. we aimed this study to assess the role of endoscopic ultrasound in diagnosis and staging of carcinoma gall bladder

MATERIALS AND METHODS: 25 patients (20 females) with mean age 53.2 ± 11.84 years with the diagnosis of CaGB  who met the inclusion criteria were enrolled into the study.12 were operated in which the HPR reports  were collected and  compared with their corresponding EUS and CT finding. In the remaining 13 inoperable patients EUS finding was compared with CT finding.

RESULTS: Among the operated  patients sensitivity and positive predictive value  of  EUS  in detecting T1,T2,T3,N0,N1 nodes were (100% & 100%),(100% & 100%),(83.3 & 83.3%) -(87.5%&77.8%),(66.7%&100.0%)  respectively compared to CT which had-(100% & 50%), 0 %,(66.7% & 66.7%) (87.5%&77.8%),(66.7%&66.7%) respectively. EUS has a high sensitivity and positive predictive value when compared to CT in T staging with a P value of 0.001. Significant association between EUS and HPR was noted compared to CT in T staging. In N1 nodal staging it had similar sensitivity but a high positive predictive value when compared to CT This may be useful as patients with N1 positivity has significantly worse survival.  N2 nodal involvement assessment couldn’t be done as these patients were not operated,and so histopathological correlation couldn’t be made .No association was noted between the two tests in the inoperable patients.

CONCLUSION:EUS is useful in the  staging of gallbladder carcinoma.

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