Ultrasound in the diagnosis of gall-bladder carcinoma in Chinese patients.
A review of the ultrasound (US) findings with clinical and pathological correlation in 18 Chinese patients with gall-bladder carcinoma (GBCa) showed that the most frequent appearance was that of diffuse infiltration and thickening of the GB wall (8/18 patients, 44%). Polypoid protrusion into the GB lumen (5/18 patients, 28%) and massive replacement of the entire GB (5/18 patients, 28%) accounted for the remainder. The infiltrating type of tumour was poorly-detected by US (1/8) and was more frequently seen than has been reported in the Western population. Frequent associations with GB calculi (13/18) and synchronous presentation of biliary sepsis (6/18) also contributed to a modest overall US detection rate of 50% (9/18) in this series. Most tumours detected by US were hyperechoic in appearance (6/9). Biliary obstruction was detected by US in 5/6 patients, but only thought to be malignant in 3/6. It most often occurred due to spread of tumour to peripancreatic lymph nodes. Hepatic metastases were seen by US in 4/5 patients. Discontinuous GB wall calcification and non-dependent stones due to elevation by tumour (the 'elevated stone' sign) were infrequent but reliable signs of GBCa, seen in 5/18 and 3/18 respectively. This study suggests that GBCa is as difficult to detect sonographically in Chinese patients as in the Western population. GBCa must be included in the differential diagnosis of causes of both the acutely-presenting 'hot' gall-bladder and lymph node masses in the peripancreatic region if the US detection rate of this important biliary malignancy is to be improved.
Daly
B D
BD
Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Cheung
H
H
Arnold
M
M
Metreweli
C
C
D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging; D002681:China / Q000208:ethnology; D002769:Cholelithiasis / Q000000981:diagnostic imaging; D005069:Evaluation Studies as Topic; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000473:pathology; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011127:Polyps / Q000000981:diagnostic imaging / Q000208:ethnology; D012189:Retrospective Studies; D014463:Ultrasonography