Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: A hospital-based retrospective observational study and our experience

Abstract

Purpose: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. Subjects and Methods: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. Results: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. Conclusion: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder. Dwivedi AND 1 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Pandey M 2 Department of Surgery, Institute of Medical Sciences, BHU, Varanasi Shukla R 3 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Shukla V 4 Department of Surgery, Institute of Medical Sciences, BHU, Varanasi Gaharwar S 5 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Maurya B 6 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Shukla VK, Khandelwal C, Roy SK, Vaidya MP. Primary carcinoma of gall bladder: A review of a 16-year period at the university hospital. J Surg Oncol 1985;28:32-5. National Cancer registry Programme: Consolidated report of the population based cancer registries 1990-1996, Incidence and distribution of cancer, New Delhi: Indian Council of Medical Research, ICMR; 2001. p. 52-3. Kapoor VK, Mc Michael AJ. Gall Bladder Cancer: An ′Indian" disease. Natl Med J India 2003;16:209-13. Maram ES, Ludwig J, Kurland LT, Brian DD. Carcinoma of the gallbladder and extrahepatic biliary ducts in Rochester, Minnesota, 1935-1971. Am J Epidemiol 1979;109:152-75. Nervi F, Duarte I, Gomez G, Rodreguez G, Delpino G, Ferrerio O, et al. Frequency of the gallbladder cancer in Chile. Int J Cancer 1988;41:657. Soira M, Aro K, Pamilo M, Palvansalo M, Suramo I, Taavitsainen M. ultrasonography in carcinoma of gall bladder. Acta Radiol 1987;28:711-4. Palma LD, Rizzatto G, Pozzi-Mercerri RS, Bazzoccbi M. Gray scale ultrasonography in the evaluation of the carcinoma of the gall bladder. Br J Radiol 1980;53:662-7. Itai Y, Araki T, Yoshikawa K, Fureri S, Yashiro N, Tasaka A. Computed tomography of gall bladder carcinoma. Radiology 1980;137:713-8. Zatonski WA, La Vecchia C, Przewozniak K, maisonneuve P, Lowenfels AB, Boyle P. Risk factors for gall bladder cancer: A polish case control study. Int J Cancer 1992;51:707-11. Strom BL, Soloway RD, Rioz-Palenz JL, Rodriguez-Martinez HA, West SL, Kinman JL, et al. Risk factors for gallbladder cancer. Cancer 1995;76:1747-56. Zatonski WA, Lowenfels AB, Boyle P, Maisonneuve P, Bruno De Mesquita HB, Ghadirian P, et al. Epidemiologic aspects of gall bladder cancer. A case control study of the search programme of the International agency for Research on Cancer. J Natl Cancer Inst 1997;89:1132-8. Kats K, Akai S, Tominaga S, Kato I. A case control study of biliary tract cancer in Nigata Prefecture, Japan. Jpn J Cancer Res 1989;80:932-8. Waterhouse J, Muir C, Correa P, Powell J, editors. Cancer incidence in five continents, Vol 3, IARC Publication No. 15. Lyon: IARC; 1976. Zeman RK, Burrell Ml, editors. Gallbladder and Bile Duct Imaging: A clinical radiologic approach. New York: Churchill Livingstone; 1987. p. 292-307. Chaurasia P, Thakur MK, Shukla HS. What causes cancer gallbladder?: A review. HPB Surg 1999;11:217-24. Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA. Gallbladder carcinoma update: Multimodality imaging evaluation, staging and treatment options. AJR Am J Roentgenol 2008;191:1440-7. Nakayama F. Recent progress in the diagnosis and gtreatment of carcinoma of gall bladder: Introduction. World J Surg 1991;15:313-4. Piehler JM, crichlow RW. Primary carcinoma of gall bladder. A collective review. Surg Gynecol Obstet 1978;147:929-42. Pandey M, Gautam A, Shukla VK. ABO and Rh blood groups in patients with cholelithiasis and carcinoma of the gall bladder. Br Med J 1995;310:1639. Shukla VK, Shukla PK, Pandey M, Rao BR, Roy SK. Lipid peroxidation products in bile from patients with carcinoma of the gall bladder. A preliminary study. J Surg Oncol 1994;54:258-62. Pandey M, Shukla PK, Gautam A, Rao BR, Roy SK, Shukla VK. Increased peroxidation of polyunsaturated fatty acids: A possible link in the peroxidant pathogenesis of carcinoma of the gallbladder with cholelithiasis. Proc. UICC XVI International Cancer Congress, Monduzzi Editore, Roma, Italy 1994; 3: 2055-8.. Shukla VK, Tiwari SC, Roy SK. Biliary bile acids in cholelithiasis and carcinoma of the gall bladder. Eur J Cancer Prev 1993;2:155-60. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81. Silk YN, Dougras HO Jr, Nava HR, Driscoll DL, Tartarian G. Carcinoma of the gall bladder. The Rosewerr Park experience. Ann Surg 1989;210:751-7. Pandey M, Pathak AK, Gautam A, Aryya NC, Shukla VK. Digestive diseases and sciences. Dig Dis Sci 2001;46:1145-51. Yoshimitsu K, Honda H, Shinozaki K, Aibe H, Kuroiwa T, Irie H, et al. Helical CT of the local spread of carcinoma of the gall bladder: Evaluation of the gall bladder: Evaluation according to the TNM system in patients who underwent surgical resection. AJR Am J Roentgenol 2002;179:423-8. Grand D, Horton MK, Fishman EK. CT of the gall bladder: Spectrum of disease. AJR Am J Roentgenol 2004;183:163-70. Rckert JC, Rckert RI, Gellert K, Hecker K, Mller JM. Surgery for carcinoma of the gallbladder. Hepatogastroenterology 1996;43:527. Fong Y, Wagman L, Gonen M, Crawford J, Reed W, Swanson R, et al. Evidence-based gallbladder cancer staging: Changing cancer staging by analysis of data from the National Cancer Database. Ann Surg 2006;243:767. Kiran RP, Pokala N, Dudrick SJ. Incidence pattern and survival for gallbladder cancer over three decades-an analysis of 10301 patients. Ann Surg Oncol 2007;14:827. Kapoor VK, Pradeep R, Haribhakti SP, Sikora SS, Kaushik SP. Early carcinoma a of gall bladder: An elusive disease. J Surg Oncol 1996;62:284-7.