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Review
. 2021 Aug 31;11(9):1586.
doi: 10.3390/diagnostics11091586.

The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

Susumu Hijioka  1 , Yoshikuni Nagashio  1 , Akihiro Ohba  1 , Yuta Maruki  1 , Takuji Okusaka  1
Affiliations
Review

The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

Susumu Hijioka et al. Diagnostics (Basel). .

Abstract

Endoscopic ultrasonography (EUS) has greater spatial resolution than other diagnostic imaging modalities. In addition, if gallbladder lesions are found and gallbladder cancer is suspected, EUS is an indispensable modality, enabling detailed tests for invasion depth evaluation using the Doppler mode and ultrasound agents. Furthermore, for gallbladder lesions, EUS fine-needle aspiration (EUS-FNA) can be used to differentiate benign and malignant forms of conditions, such as xanthogranulomatous cholecystitis, and collect evidence before chemotherapy. EUS-FNA is also useful for highly precise and specific diagnoses. However, the prevention of bile leakage, an accidental symptom, is highly important. Advancements in next-generation sequencing (NGS) technologies facilitate the application of multiple parallel sequencing to EUS-FNA samples. Several biomarkers are expected to stratify treatment for gallbladder cancer; however, NGS can unveil potential predictive genomic biomarkers for the treatment response. It is believed that NGS may be feasible with samples obtained using EUS-FNA, further increasing the demand for EUS-FNA.

Keywords: EUS fine-needle aspiration (EUS-FNA); Endoscopic ultrasonography (EUS); cholecystitis gallbladder lesions; gallbladder carcinoma; xanthogranulomatous.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Early-stage gallbladder cancer (m) type I. (a) Endoscopic ultrasonography: Broad-based elevated lesion in the gallbladder body. Nodular surface structure and slightly non-uniform internal echo. Regular hyperechoic external layer of the gallbladder wall where the lesion is attached. (b) Magnified image: Papillary-shaped tumor. Low papillary-shaped lesion contiguous with the base of the papillary-shaped lesion. No invasion of the proper muscular layer.
Figure 2
Figure 2
Gallbladder adenoma. (a) Endoscopic ultrasonography (EUS): Pedunculated elevated lesion (arrow). (b) EUS (Doppler mode): Linear blood flow in the peduncle.
Figure 3
Figure 3
Intracystic papillary neoplasm (ICPN; adenocarcinoma: m). (a,b) Endoscopic ultrasonography (EUS): Broad-based elevated lesion.
Figure 4
Figure 4
Pancreaticobiliary maljunction with gallbladder wall thickening. (a) Endoscopic ultrasonography (EUS): Diffuse low papillary-shaped elevated lesion in the gallbladder (arrow). (b) Endoscopic ultrasonography: Pancreaticobiliary duct junction in the pancreatic parenchyma. CBD; common hepatic duct, MPD; main pancreatic duct (c) ERP: Findings of the pancreatic duct junction-type maljunction.
Figure 5
Figure 5
Xanthogranulomatous cholecystitis. (a) Abdominal ultrasonography: Wall thickening around the entire gallbladder and gall stone in the neck (arrow head). (b) Contrast-enhanced computed tomography: Marked wall thickening and poorly marginated border with liver parenchyma. (c) Endoscopic ultrasonography (EUS): Marked wall thickening (arrow).
Figure 6
Figure 6
Comparison of gallbladder layer and EUS findings.
Figure 7
Figure 7
T3 gallbladder cancer. (a) Contrast-enhanced computed tomography: enhanced gallbladder mass in the body. (b) Endoscopic ultrasonography: hypoechoic tumor in the gallbladder with no hyperechoic outer layer.
Figure 8
Figure 8
EUS-FNA of the gallbladder. (a,b) A case of gallbladder cancer: a thickened part of the gallbladder wall punctured while avoiding the gallbladder lumen.
See this image and copyright information in PMC

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