title: Role of routine 16b1 lymph node biopsy in the management of gallbladder cancer: an analysis.
abstract: BACKGROUND
  Involvement of the 16b1 (interaortocaval) lymph node (LN) in gallbladder cancer (GBC) is considered to represent metastatic disease. Although this is universally accepted, the role of routine frozen-section histopathological examination (HPE) of the 16b1 LN in the management of GBC has not been previously reported.
  
  
  METHODS
  A prospective study (August 2009-November 2011) using routine biopsy of 16b1 LNs and frozen-section HPE prior to radical resection in patients deemed operable on preoperative evaluation and staging laparoscopy was carried out.
  
  
  RESULTS
  Of the 451 GBC patients assessed, 251 (55.7%) were deemed operable on preoperative imaging. Of these, 68 (27.1%) were found to have disseminated disease on staging laparoscopy/laparotomy. Of the 183 patients in whom 16b1 LN biopsy was performed, 34 (18.6%) had evidence of metastases on frozen-section HPE and the planned surgical resection was abandoned (Group A). Of the remaining 149 patients (Group B), 142 (95.3%) underwent curative resection and seven (4.7%) were found to be unresectable as a result of locoregionally advanced disease. A comparison of findings in Group A with those in Group B showed no significant difference in the clinical stage of the tumour. The proportions of patients with jaundice, elevated carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were significantly higher in Group A than in Group B (P = 0.008, P = 0.012 and P = 0.023, respectively).
  
  
  CONCLUSIONS
  Routine 16b1 LN biopsy prevented non-therapeutic radical resection and its associated morbidity in 18.6% of patients deemed resectable on preoperative imaging and staging laparoscopy. The yield was higher in patients with jaundice and elevated preoperative tumour marker levels.
authors.affiliation: Department of Gastrointestinal Surgery and Pathology, Govind Ballabh Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Agarwal
authors.forename: Raja
authors.initials: R
authors.lastname: Kalayarasan
authors.forename: Amit
authors.initials: A
authors.lastname: Javed
authors.forename: Puja
authors.initials: P
authors.lastname: Sakhuja
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005629:Frozen Sections; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000628:therapy; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055815:Young Adult