Systemic approach in diagnosis of Gall bladder mass by Ultrasonography and Computed tomography and its correlation with Fine needle aspiration cytology

Abstract

Introduction: Carcinoma of gallbladder (GB) is the most common malignant tumor of the biliary tree. It is highly lethal, median survival being six months. Proper evaluation and development of a systemic approach in cross sectional noninvasive imaging play key role in early diagnosis of GB mass. Ultrasonography (USG) is the initial screening tool for suspected GB neoplasms. USG abdomen has certain limitations like interference by bowel gas, limited depth resolution and posterior acoustic shadowing in the presence of calculi. Computed Tomography (CT) scan overcomes these drawbacks. CT provides definitive information regarding locoregional spread, distant metastasis and involvement of the biliary tree and portal vein. Aims and Objectives: Role of USG and CECT in evaluation of gallbladder (GB) masses. Materials and Methods: This study was conducted in the Department of Radio diagnosis in coordination with the surgery and pathology at KIMS Bhubaneshwar. A total of 50 patients with suspected GB masses were included in our study. Result: Maximum no of patients (50%) were in the age group of 61-70 year and female to male ratio was 1.6:1. GBCA was diagnosed in 48 (96%) patients on USG whereas in 49 (98%) patients on CECT. Mass detection as heterogeneous echotexture mostly hypoechoic seen in 39 (78%) patients on USG and heterodense mostly hypodense on CECT in 41 (82%) patients. Mass filling the GB lumen complete or partial was detected in 38(76%) patients on USG and on CECT in 42(84%) patients. Focal wall thickening was detected in 21(42%) patients on USG and 30 (60%) patients on CECT. Diffuse wall thickening of Gall bladder seen in 5 (10%) patients in both USG and CECT. Conclusion: Carcinoma GB is most common in elderly females. GB calculus is an important risk factor for Gall bladder carcinoma. CECT abdomen is superior to USG in characterization of GB masses, dilated CBD, bilobar IHBRD, adjacent bowel invasion and loco regional lymphadenopathy. USG abdomen is better than CECT abdomen in detection of GB calculus and both have similar accuracy in detecting porcelain Gall bladder.