title: Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.
abstract: OBJECTIVE
  The differential diagnosis of gallbladder (GB) cancer from inflammatory diseases in patients with a thickened GB wall is difficult, whereas the pre-operative diagnosis of GB cancer is critical for selecting the appropriate surgical modality. We evaluated the clinical usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of GB wall thickening.
  
  
  METHODS
  The medical records, post-operative pathology reports, and images of EUS for 134 patients with GB wall thickening (>3 mm) who underwent laparoscopic or open cholecystectomies at our institution between December 2006 and February 2010 were retrospectively reviewed.
  
  
  RESULTS
  Thirteen patients (9.7%) had neoplastic GB wall thickening (11 with adenocarcinomas and two with adenosquamous carcinomas) and the remaining 121 patients (90.3%) had non-neoplastic GB wall thickening (117 with inflammatory GB wall thickening and four with adenomyomatosis). The mean (± standard deviation [SD], mm) GB wall thickness was 6.5 ± 3.3 and 19.4 ± 7.7 for non-neoplastic and neoplastic GB wall thickening, respectively (P < 0.01). The EUS variables which had a statistically significant association with neoplastic GB wall thickening were GB wall thickening >10 mm, disruption of the normal two layers of the GB wall, hypoechoic internal echogenecity, and the absence of gallstones. Based on the multivariate analyses, GB wall thickening >10 mm and hypoechoic internal echogenecity were independent predictive factors for neoplastic GB wall thickening.
  
  
  CONCLUSIONS
  The diagnostic power of EUS for differentiating neoplastic and non-neoplastic GB wall thickening could be improved by the appropriate application of some EUS variables.
authors: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, South Korea. hongjoo3.kim@samsung.com
authors: Hong Joo
authors: HJ
authors: Kim
authors: Jung Ho
authors: JH
authors: Park
authors: Dong Il
authors: DI
authors: Park
authors: Yong Kyun
authors: YK
authors: Cho
authors: Chong Il
authors: CI
authors: Sohn
authors: Woo Kyu
authors: WK
authors: Jeon
authors: Byung Ik
authors: BI
authors: Kim
authors: Seon Hyeong
authors: SH
authors: Choi
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology*; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity