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. 2024 Sep;10(3):176-181.
doi: 10.5114/ceh.2024.143058. Epub 2024 Sep 30.

Multifocality in gallbladder cancer: An imaging-based study

A B Pooja  1 , Daneshwari Kalage  1 , Chandra Shekhar Singh Aswal  1 , Thakur Deen Yadav  2 , Lileswar Kaman  3 , Santosh Irrinki  3 , Parikshaa Gupta  4 , Gaurav Prakash  5 , Uma Nahar Saikia  6 , Ritambhra Nada  6 , Usha Dutta  7 , Pankaj Gupta  1
Affiliations

Multifocality in gallbladder cancer: An imaging-based study

A B Pooja et al. Clin Exp Hepatol. 2024 Sep.

Abstract

Aim of the study: Gallbladder cancer (GBC) lesions are usually solitary. The presence of multifocal disease can alter resectability and management. There are no systematic imaging-based studies evaluating multifocality in GBC. Thus, we aimed to evaluate multifocality in GBC based on cross-sectional imaging studies.

Material and methods: This retrospective study screened cross-sectional imaging (contrast-enhanced computed tomography [CT] or magnetic resonance imaging [MRI]) of consecutive patients with histopathological or cytological diagnoses of GBC. The CT/MRI images of patients with multifocal disease (defined as the presence of two or more foci of abnormal wall thickening, intraluminal polypoidal lesions or masses in the gallbladder, cystic duct, or the extrahepatic bile ducts with the intervening area of normal gallbladder/extrahepatic bile ducts) were evaluated by two radiologists independently for various imaging findings.

Results: Of the 324 patients, 17 (5.2%; 13 females; mean age, 54 ±11 years) had multifocal disease with two sites of involvement in all cases. The most common sites of involvement were the gallbladder fundus and neck region (58.8% of cases), followed by the gallbladder fundus and common bile duct (29.4%). Wall thickening type of GBC was the most common morphological subtype (85.3%), followed by mass forming type (14.7%). The majority (70.6%) of cases showed the same morphology at both sites, while 29.4% showed different morphology. Most (70.6%) of the patients with multifocal GBC were unresectable at the time of diagnosis.

Conclusions: Although rare, imaging-based diagnosis of multifocal GBC may allow appropriate management.

Keywords: CT; MRI; biliary malignancies; gallbladder cancer.

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Conflict of interest statement

This research received no external funding. The study was approved by the Bioethics Committee of the Postgraduate Institute of Medical Education and Research, Chandigarh, India (Approval No. IEC/INT/2023/Study-1231). The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Axial (A, C) and coronal reformatted (B, D) contrast-enhanced CT images of abdomen in a 39-year-old woman with histopathological diagnosis of gallbladder cancer show enhancing mural thickening in gallbladder fundus (solid white arrow) that has an indistinct interface with adjacent liver segments. There is enhancing mural thickening of the common bile duct (white arrowhead), causing upstream biliary dilatation. The confirmation of multifocal disease was based on endoscopic retrograde cholangiopancreatography-guided brush cytology from common bile duct thickening and ultrasound-guided fine needle aspiration cytology from the gallbladder lesion
See this image and copyright information in PMC

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