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Incidentally Detected Gallbladder Carcinoma: Can F-18 FDG PET/CT Aid in Staging and Prognostication?

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Abstract

Purpose

Incidental gallbladder carcinoma (IGBC) is diagnosed in post-cholecystectomy specimens for benign indications, where the role of 2-fluro-2-deoxyglucose positron emission tomography/computed tomography(FDG-PET/CT) is not clearly defined. The present study aimed to assess the benefits of staging and prognosticating with FDG-PET/CT in IGBC.

Materials and Methods

A retrospective observational study from a tertiary-care center from January 2010 to July 2020 was performed. The demographic, clinical, histopathological, and treatment-related histories were collected. FDG-PET/CT-image findings were compared with survival outcomes through telephonic follow-up. The chi-square test was used for comparing frequencies. The univariate and multivariate survival estimates were analyzed using the Kaplan–Meier analysis and the Cox-proportional hazard model, respectively. Log-rank test was used to compare the Kaplan–Meier curves.

Results

The study included 280 postcholecystectomy participants (mean age: 52 ± 11 years; women: 227) of whom 52.1% had open surgery(146/280). Residual disease in the gallbladder fossa (54.8% vs. 36.6%, p = 0.002) and liver infiltration (32.9% vs. 22.4%, p = 0.05) were seen more frequently in open surgery compared to laparoscopic surgery, while anterior abdominal wall deposits were more common in laparoscopy(35.1% vs. 24%,p = 0.041). FDG-PET/CT changed the management in 10% (n = 28) of patients compared to contrast-enhanced CT. The median survival was 14 months (95%CI-10.3–17.7). A higher stage of the disease on the FDG-PET/CT (loco-regional disease-HR 4.86, p = 0.006; metastatic disease-HR 7.53, p < 0.001) and the presence of liver infiltration (HR-1.92, p = 0.003) were independent predictors of poor survival outcomes.

Conclusion

FDG-PET/CT detects residual and metastatic disease in patients with IGBC, enabling the institution of appropriate management and acting as a tool for prognostication of survival.

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Data availability

Data generated and analyzed can be availed from the corresponding author on a reasonable request.

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Author notes

  1. Venkata Subramanian Krishnaraju and Rajender Kumar both contributed equally as first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Venkata Subramanian Krishnaraju, Rajender Kumar, Bhagwant Rai Mittal, Piyush Aggarwal & Harmandeep Singh

  2. Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Harjeet Singh, Thakur Deen Yadav, Vikas Gupta & Rajesh Gupta

  3. Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Ritambhra Nada

Authors
  1. Venkata Subramanian Krishnaraju
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  9. Vikas Gupta
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Contributions

All authors have made a significant contribution in formulating, reviewing, and editing the manuscript.

Corresponding author

Correspondence to Bhagwant Rai Mittal.

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Competing Interests

Venkata Subramanian Krishnaraju, Rajender Kumar, Bhagwant Rai Mittal, Harjeet Singh, Piyush Aggarwal, Harmandeep Singh, Thakur Deen Yadav, Ritambhra Nada, Vikas Gupta, and Rajesh Gupta declare that they have no competing interest.

Ethics Approval and Consent to Participate

This study was performed in accordance with the ethical standards as laid down in the 2013 Declaration of Helsinki and its later amendments or comparable ethical standards. The institutional review board waived the requirement for written consent.

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Informed consent was obtained from the participants for the study mentioned as a part of the institutional protocol.

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Krishnaraju, V.S., Kumar, R., Mittal, B.R. et al. Incidentally Detected Gallbladder Carcinoma: Can F-18 FDG PET/CT Aid in Staging and Prognostication?. Nucl Med Mol Imaging 58, 104–112 (2024). https://doi.org/10.1007/s13139-024-00841-w

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  • DOI: https://doi.org/10.1007/s13139-024-00841-w

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