GALLBLADDER CANCER: CHARACTERIZING PRIMARY TUMOR AND NODAL SPREAD

Objective: Presence of many surgico-pathological staging systems and acceptance of number of lymph nodes for deciding N stage in AJCC TNM 2010 staging system in gall bladder cancer may indicate suboptimal staging. Aim of the study is to assess the different radiological profile and corresponding lymph node spread using ultrasound and CT scan to propose a new radiological staging system. Methods: This observational cross sectional study included 187 patients of histopathologically proven gall bladder carcinoma who underwent abdominal USG and CECT. Scans were evaluated for morphology of tumour, vascularity, loco-regional spread and nodes. The statistical analysis was done using IBM SPSS version 20.0. A two-sided chi-square test of association was applied for pattern of GB cancer and nodal spread. Additional role of CECT in addition to USG was assessed. Result: There was definite female preponderance with female: male ratio of 2:1. In both sexes of age group 40 or more than 40 years had preponderance of imaging pattern of mass replacing gallbladder (36.7%). Lymph nodal spread occurred in 71.1% of cases with periportal being the initial site (97.74%). USG missed nodes in 12 patients which were detected on CECT. The frequency of lymph node involvement is strongly influenced by the depth of invasion of the primary tumor (52.8%). Conclusion: CECT provides additional benefit from USG in assessing the nodal spread of gall bladder carcinoma. Having a radiological preoperative staging system will better define surgical technique/preoperative neoadjuvant or concurrent chemoradiotherapy schedule. Keywords: Gallbladder, cancer, radiological, staging, lymph nodes