Skip to main content
SpringerLink
Log in

Gastrointestinal involvement in gallbladder cancer: Computed tomography findings and proposal of a classification system

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

There is relatively scarce data on the computed tomography (CT) detection of gastrointestinal (GI) involvement in gallbladder cancer (GBC). We aim to assess the GI involvement in GBC on CT and propose a CT-based classification.

Methods

This retrospective study comprized consecutive patients with GBC who underwent contrast-enhanced computed tomography (CECT) for staging between January 2019 and April 2022. Two radiologists evaluated the CT images independently for the morphological type of GBC and the presence of GI involvement. GI involvement was classified into probable involvement, definite involvement and GI fistulization. The incidence of GI involvement and the association of GI involvement with the morphological type of GBC was evaluated. In addition, the inter-observer agreement for GI involvement was assessed.

Results

Over the study period, 260 patients with GBC were evaluated. Forty-three (16.5%) patients had GI involvement. Probable GI involvement, definite GI involvement and GI fistulization were seen in 18 (41.9%), 19 (44.2%) and six (13.9%) patients, respectively. Duodenum was the most common site of involvement (55.8%), followed by hepatic flexure (23.3%), antropyloric region (9.3%) and transverse colon (2.3%). There was no association between GI involvement and morphological type of GBC. There was substantial to near-perfect agreement between the two radiologists for the overall GI involvement (k = 0.790), definite GI involvement (k = 0.815) and GI fistulization (k = 0.943). There was moderate agreement (k = 0.567) for probable GI involvement.

Conclusion

GBC frequently involves the GI tract and CT can be used to categorize the GI involvement. However, the proposed CT classification needs validation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

All data related to the manuscript has been provided in the manuscript.

References

  1. Dutta U, Bush N, Kalsi D, Popli P, Kapoor VK. Epidemiology of gallbladder cancer in India. Chin Clin Oncol. 2019;8:33.

    Article  PubMed  Google Scholar 

  2. Goetze TO. Gallbladder carcinoma: prognostic factors and therapeutic options. World J Gastroenterol. 2015;21:12211–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cocco G, Delli Pizzi A, Basilico R, et al. Imaging of gallbladder metastasis. Insights Imaging. 2021;12:100.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cocco G, Basilico R, Delli Pizzi A, et al. Gallbladder polyps ultrasound: what the sonographer needs to know. J Ultrasound. 2021;24:131–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gupta P, Dutta U, Rana P, et al. Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus. Abdom Radiol (NY). 2022;47:554–65.

    Article  PubMed  Google Scholar 

  6. Gupta P, Meghashyam K, Marodia Y, et al. Locally advanced gallbladder cancer: a review of the criteria and role of imaging. Abdom Radiol (NY). 2021;46:998–1007.

    Article  PubMed  Google Scholar 

  7. Marodia Y, Kharel J, Saikia UN, et al. Association of CT findings with perineural invasion in gallbladder cancer: preliminary assessment. AJR Am J Roentgenol. 2022;9:1–2.

  8. Choi SY, Kim JH, Lim S, Lee JE, Park HJ, Lee B. CT-based nomogram for predicting survival after R0 resection in patients with gallbladder cancer: a retrospective multicenter analysis. Eur Radiol. 2021;31:3336–46.

    Article  PubMed  Google Scholar 

  9. Choi SY, Kim JH, Park HJ, Han JK. Preoperative CT findings for prediction of resectability in patients with gallbladder cancer. Eur Radiol. 201929:6458–68.

  10. Boccatonda A, Cocco G, D’Ardes D, Schiavone C. GB-RADS score, a possible role for CEUS? Abdom Radiol (NY). 2023;48:1199–201.

    PubMed  Google Scholar 

  11. Kalra N, Suri S, Gupta R, et al. MDCT in the staging of gallbladder carcinoma. AJR Am J Roentgenol. 2006;186:758–62.

    Article  PubMed  Google Scholar 

  12. Kim SJ, Lee JM, Lee JY, et al. Accuracy of preoperative T-staging of gallbladder carcinoma using MDCT. AJR Am J Roentgenol. 2008;190:74–80.

    Article  PubMed  Google Scholar 

  13. Agarwal AK, Mandal S, Singh S, Sakhuja P, Puri S. Gallbladder cancer with duodenal infiltration: is it still resectable? J Gastrointest Surg. 2007;11:1722–7.

    Article  PubMed  Google Scholar 

  14. Kalayarasan R, Javed A, Puri AS, Puri SK, Sakhuja P, Agarwal AK. A prospective analysis of the preoperative assessment of duodenal involvement in gallbladder cancer. HPB (Oxford). 2013;15:203–9.

    Article  PubMed  Google Scholar 

  15. Fahim RB, McDonald JR, Richards JC, Ferris DO. Carcinoma of the Gallbladder: a Study of its Modes of Spread. Ann Surg. 1962;156:114–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Dwivedi AND, Jain S, Dixit R. Gall bladder carcinoma: aggressive malignancy with protean loco-regional and distant spread. World J Clin Cases. 2015;3:231–44.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Scheingraber S, Justinger C, Stremovskaia T, Weinrich M, Igna D, Schilling MK. The standardized surgical approach improves outcome of gallbladder cancer. World J Surg Oncol. 2007;5:55.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Raghuraman Soundararajan, Srivardhan Vanka, Pankaj Gupta, Manika Chhabra, Pratyaksha Rana, Ajay Gulati & Manavjit Singh Sandhu

  2. Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Chandan K. Das

  3. Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Parikshaa Gupta

  4. Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Uma Nahar Saikia

  5. Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Thakur Deen Yadav, Vikas Gupta & Harjeet Singh

  6. Department General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Lileswar Kaman & Santosh Irrinki

  7. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Usha Dutta

Authors
  1. Raghuraman Soundararajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Srivardhan Vanka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pankaj Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manika Chhabra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pratyaksha Rana
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ajay Gulati
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chandan K. Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Parikshaa Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Uma Nahar Saikia
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Thakur Deen Yadav
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vikas Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lileswar Kaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Harjeet Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Santosh Irrinki
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Usha Dutta
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Manavjit Singh Sandhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RS, SV, PG, MC, PR: data acquisition, analysis, initial draft, revision and final approval. AG, CKD, PG, UNS, TDY, VG, LK, HS, SI, UD, MSS: data acquisition, revision and final approval.

Corresponding author

Correspondence to Pankaj Gupta.

Ethics declarations

Ethics approval

The study was approved by the PGIMER Institute Ethics Committee (IEC-INT/2022/Study-460).

Consent for publication

Not applicable.

Conflict of interest

RS, SV, PG, MC, PR, AG, CKD, PG, UNS, TDY, VG, LK, HS, SI, UD and MSS declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Soundararajan, R., Vanka, S., Gupta, P. et al. Gastrointestinal involvement in gallbladder cancer: Computed tomography findings and proposal of a classification system. Indian J Gastroenterol 42, 708–712 (2023). https://doi.org/10.1007/s12664-023-01388-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-023-01388-y

Keywords

Search

Navigation