Lee TY, Ko SF, Huang CC, Ng SH, Liang JL, Huang HY, Chen MC, Sheen-Chen SM. Intraluminal versus infiltrating gallbladder carcinoma: Clinical presentation, ultrasound and computed tomography. World J Gastroenterol 2009; 15(45): 5662-5668 [PMID: 19960562 DOI: 10.3748/wjg.15.5662]
Corresponding Author of This Article
Sheung-Fat Ko, MD, Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China. sfa.ko@msa.hinet.net
Article-Type of This Article
Original Article
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Tze-Yu Lee, Sheung-Fat Ko, Chung-Cheng Huang, Shu-Hang Ng, Jiun-Lung Liang, Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung Hsien 833, Taiwan, China
Hsuan-Ying Huang, Department of Pathology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung Hsien 833, Taiwan, China
Min-Chi Chen, Public Health and Biostatistics Consulting Center, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung Hsien 833, Taiwan, China
Shyr-Ming Sheen-Chen, Department of Surgery, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung Hsien 833, Taiwan, China
Shyr-Ming Sheen-Chen, Department of Surgery, Xiamen Chang Gung Hospital, Xiamen 361000, Fujian Province, China
Author contributions: Lee TY and Ko SF were the guarantors of integrity of the entire study; Lee TY, Ko SF and Huang HY provided the study concepts and design; Lee TY, Huang CC, Ng SH and Liang JL performed the literature research; Lee TY, Liang JL, Huang HY and Sheen-Chen SM performed the clinical and pathological studies and data acquisition; Lee TY, Ko SF and Chen MC performed the data and statistical analyses; Lee TY, Ko SF and Liang JL prepared the manuscript; Ko SF, Ng SH and Sheen-Chen SM provided the intellectual content and editing of the manuscript; All authors approved the final version of the manuscript.
Correspondence to: Sheung-Fat Ko, MD, Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, China. sfa.ko@msa.hinet.net
Received: September 30, 2009 Revised: October 26, 2009 Accepted: November 3, 2009 Published online: December 7, 2009
Abstract
AIM: To compare clinical presentation and ultrasound (US) and computed tomography (CT) sensitivity between intraluminal and infiltrating gallbladder carcinoma (GBCA).
METHODS: This retrospective study evaluated 65 cases of GBCA that were categorized morphologically into the intraluminal-GBCA (n = 37) and infiltrating-GBCA (n = 28) groups. The clinical and laboratory findings, presence of gallstones, gallbladder size, T-staging, nodal status, sensitivity of preoperative US and CT studies, and outcome were compared between the two groups.
RESULTS: There were no significant differences between the two groups with respect to female predominance, presence of abdominal pain, serum aminotransferases level, T2-T4 staging, and regional metastatic nodes. Compared with the patients with intraluminal-GBCA, those with infiltrating-GBCA were significantly older (65.49 ± 1.51 years vs 73.07 ± 1.90 years), had a higher frequency of jaundice (3/37 patients vs 13/28 patients) and fever (3/37 patients vs 10/28 patients), higher alkaline phosphatase (119.36 ± 87.80 IU/L vs 220.68 ± 164.84 IU/L) and total bilirubin (1.74 ± 2.87 mg/L vs 3.50 ± 3.51 mg/L) levels, higher frequency of gallstones (12/37 patients vs 22/28 patients), smaller gallbladder size (length, 7.47 ± 1.70 cm vs 6.47 ± 1.83 cm; width, 4.21 ± 1.43 cm vs 2.67 ± 0.93 cm), and greater proportion of patients with < 12 mo survival (16/37 patients vs 18/28 patients). The sensitivity for diagnosing intraluminal-GBCA with and without gallstones was 63.6% and 91.3% by US, and 80% and 100% by CT, respectively. The sensitivity for diagnosing infiltrating-GBCA with and without gallstones was 12.5% and 25% by US, and 71.4% and 75% by CT, respectively.
CONCLUSION: In elderly women exhibiting small gallbladder and gallstones on US, especially those with jaundice, fever, high alkaline phosphatase and bilirubin levels, CT may reveal concurrent infiltrating-GBCA.
