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.