Performance of the diagnostic images for the diagnosis of gallbladder cancer

Abstract

Background: Gallbladder cancer (GC) is a rare malignant pathology that is difficult to diagnose. The literature shows that the performance of images to recognize biliary pathology such as ultrasonography (USG), magnetic resonance cholangiography (MRCP) or computed tomography (CT) is low to diagnose GC. The imaging findings are not conclusive and can be similar to benign pathology of the gallbladder. In contrast, the minimally invasive surgical approach and the most frequency of cholecystectomies have been related to an increase in the incidental diagnosis of this cancer. Preoperative or transoperative diagnostic suspicion of malignancy is important to decide the best surgical approach. Material and Methods: Between 2015 and 2018, 1967 patients who required cholecystectomy with histopathological analysis of the gallbladder (gold standard) and had at least one imaging test were included. A diagnostic tests survey was designed to determine the sensitivity, specificity, predictive values “‹”‹and the likelihood ratio of USG, CRNM and CT for the diagnosis of GC. Results: The incidence of GC among the cases was 0.81% (16/1967). The USG was the most frequently used preoperative test (1858/1967), with a sensitivity of 9.09% and a positive predictive value of 12.5%. The MRCP was performed in 888 cases, with a sensitivity of 50% and a positive predictive value of 41.6%. The CT was performed in 230 cases, with a sensitivity of 40% and a positive predictive value of 100%. Conclusion: The performance of the diagnostic images in the GC is low because the findings are usually nonspecific and do not differentiate it from the benign biliary pathology. Unfortunately, the diagnosis of incidental GC will continue to increase due to the low sensitivity and positive predictive values “‹”‹of the diagnostic images for GC. Probably when it is identifiable by the diagnostic images you will find an advanced malignant disease.