Is ultrasonography enough to diagnose and assess resectability in gall bladder cancer
Verma, Vibha; Gupta, S.; Soni, A.S. and Nundy, S. (2002) Is ultrasonography enough to diagnose and assess resectability in gall bladder cancer. In: Proceedings of the Xllth Annual Conference of Indian Association of Surgecal Gastroentrology (IASG), 2002, Delhi, India.
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Background: In the West only 10% of gall bladder cancers (CaGB) are diagnosed preoperatively. In northern India it is fairly common and most patients present with advanced disease. They usually undergo ultrasonography (US) and CT scanning to detennine operability. We prospectively studied whether US was adequate as a single preoperative investigation for diagnosis and assessing resectability in CaGB. Patients and Methods: Between 1996 and 2002 we prospectively studied 108 patients who had CaGB. There were 58 males and 36 females, mean age was 52 (range 19-76 years). The cancer was considered to be resectable if there were no liver metastases, ascites, invasion of the main portal vein or hepatic artery or involvement of the contralateral vessels. Confirmation of the diagnosis was by laparotomy & histopathology in 63 patients. Results: Ultrasound correctly diagnosed 41 (65%) cases preoperatively. It detected 7/25(28%) cases with liver metastases and 9/52 (17%) with lymph nodes. However it only detected 1/18(5.5%) case with peritoneal metastases. CT correctly diagnosed 55/63(87%) cases preoperatively. It detected 11/25(44%) cases with liver metastases and 21/52(40%) with lymph nodes. However it only detected 4/18(22%) cases with peritoneal metastases. Conclusion: Ultrasound examination is fairly accurate for diagnosing gall bladder cancer but CT is an essential additional investigation for determining resectability. However even after both investigations in nearly half of the patients the lymph nodal and peritoneal spread of the disease is not detected.
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