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Surgical Endoscopy

, Volume 30, Issue 10, pp 4229–4238 | Cite as

Determining the extent of cholecystectomy using intraoperative specimen ultrasonography in patients with suspected early gallbladder cancer

  • Ji Hoon Park
  • Young Hoon KimEmail author
  • Haeryoung Kim
  • Yoo-Seok Yoon
  • Young Rok Choi
  • Jai Young Cho
  • Yoon Jin Lee
  • Ho-Seong Han
Article

Abstract

Background

Accumulating evidence and guidelines recommend extended cholecystectomy for T1b or greater gallbladder cancers. This study aimed to evaluate the feasibility of intraoperative ultrasonography of a resected gallbladder specimen (specimen US) for the determination of the extent of cholecystectomy.

Methods

We included 45 patients (34 women; median [interquartile range] age, 66 [57–74] years) who underwent specimen US. After simple laparoscopic cholecystectomy, a gallbladder specimen was examined to evaluate the depth of tumor invasion by specimen US and frozen section examination. With the results of those two examinations, the operating surgeon decided whether to perform extended cholecystectomy. The sensitivity and specificity of specimen US and frozen section examination in diagnosing T1b or greater cancer were, respectively, measured using permanent pathology as the reference standard. The surgeons’ final decisions were evaluated in the same manner as the intraoperative examinations.

Results

Among 22 patients in whom adenocarcinomas were confirmed, 17 patients had T1b or greater cancers. The sensitivity and specificity of specimen US alone were 81 % (95 % CI, 54–96 %) and 85 % (65–96 %), respectively. The sensitivity and specificity of frozen section examination alone were 43 % (10–82 %) and 95 % (75–100 %), respectively. Except one patient in whom extended cholecystectomy was intentionally not performed, 14 out of 16 patients (88 %; 95 % CI, 62–98 %) who were finally confirmed as having T1b or greater cancers underwent extended cholecystectomy by the surgeons’ decision based on both specimen US and frozen examination. Out of 28 patients who were finally confirmed as having benign lesions or T1a cancers, 25 (89 %; 72–98 %) underwent simple cholecystectomy.

Conclusion

Specimen US was feasible to be incorporated in clinical practice. Although the diagnostic accuracy of specimen US alone was moderate, the combined use of specimen US and frozen section examination could help the surgeons make correct decisions on the extent of cholecystectomy.

Keywords

Gallbladder neoplasms Neoplasm staging Ultrasonography Gallbladder Feasibility studies 

Notes

Acknowledgments

The authors are indebted to J. Patrick Barron, Professor Emeritus, Tokyo Medical University, and Adjunct Professor, Seoul National University Bundang Hospital, for his pro bono editing of this manuscript.

Compliance with ethical standards

Disclosures

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the MSIP (Ministry of Science, ICT, and Future Planning), Korea, under the C-ITRC (Convergence Information Technology Research Center) support program (NIPA-2014-H0401-14-1002) supervised by the NIPA (National IT Industry Promotion Agency) and Bracco Diagnostics Inc. (06-2014-262).

Supplementary material

464_2015_4733_MOESM1_ESM.docx (7.2 mb)
Supplementary material 1 (DOCX 7402 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ji Hoon Park
    • 1
    • 2
  • Young Hoon Kim
    • 1
    • 2
    Email author
  • Haeryoung Kim
    • 3
  • Yoo-Seok Yoon
    • 4
  • Young Rok Choi
    • 4
  • Jai Young Cho
    • 4
  • Yoon Jin Lee
    • 1
    • 2
  • Ho-Seong Han
    • 4
  1. 1.Department of Radiology, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnam-siKorea
  2. 2.Institute of Radiation MedicineSeoul National University Medical Research CenterSeongnam-siKorea
  3. 3.Department of PathologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnam-siKorea
  4. 4.Department of SurgerySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnam-siKorea

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