Catching Gall Bladder Cancer Early- Importance of Cholelithiasis and Radiologist

Abstract

Introduction: Increased relative risk of Gall Bladder (GB) cancer in patients with gall stones has been reported in literature but there are few reports on nature of stones. However, it is difficult to predict which patient suffering from cholelithiasis and cholecystitis may develop or already has early stages of carcinoma. Aim: The present study was undertaken to assess the malignant potential and relevance of gall stones, age and gender in GB carcinoma to propose a screening protocol and early intervention for high risk patients. Materials and Methods: This was a retrospective study done at Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India from May 2012 to May 2019. This study included 200 histopathologically- Fine Needle Aspiration Cytology (FNAC) or postoperative specimen biopsy proven GB carcinoma and 200 control patients with upper abdominal pain but without any evidence of neoplastic changes on USG. All cases and controls were subjected to USG evaluation first followed by plain CT scan with oral contrast only and Contrast Enhanced CT (CECT) scan of whole abdomen as per protocol. Scans were evaluated for detection of gall stone profile in terms of number (solitary/multiple), size (small/large) and density (radio-opaque/ radiolucent). The statistical analysis was done by using IBM Statistical Package for the Social Sciences (SPSS) version 18.0. Results: Male to female ratio in this study was 1:2. GB calculi cannot be considered as bystander as overall 25% patients of both sexes had cholelithiasis. In the present study, 25% who were having carcinoma GB have been detected to have gall stones and out of which 74% were having small calculi. The study showed the association between GB cancer and solitary and multiple large calculi over different age groups to be not statistically significant (p-value=0.3976; χ2 =0.716). Association of small and multiple calculi came out to be highly significantly associated with carcinoma in 67% of patients. Furthermore, it was observed that the association between multiple small calculi and GB cancer over the different age groups came out to be extremely statistically significant (p-value=0.0001; χ2 =28.62). The association between gall stones in GB cancer patients differ statistically significant over the age groups from cases with gall stones in control group (p-value=0.005497; χ2 =7.7082). Conclusion: From the findings of the study author proposed screening via ultrasound and guided FNAC for females over 40 years of age with multiple small calculi not undergoing immediate cholecystectomy to detect early emergence of carcinoma. It is also suggested that clinicians should post patients with multiple, small GB calculi for cholecystectomy on a priority basis and histopathology should be done in each case of GB wall thickening.

Keywords

• gall stones
• gall bladder carcinoma
• radio-opaque
• radiolucent