Abstract 296P
Background
If radical cholecystectomy is performed for a thick-walled gallbladder on suspicion of gallbladder cancer and it turns out to be acute cholecystitis, chronic cholecystitis or xanthogranulomatous cholecystitis it will be an over kill. We propose a new approach, a pre-operative USG guided FNAC, for gallbladder wall thickening/polyp where differentiation between benign and malignant is not possible on imaging.
Methods
This study conducted at a tertiary care teaching hospital between January 2016 to August 2021. the data was collected from an electronically maitained prospective database. All patients presenting with symptomatic gallstone disease showing gallbladder wall thickening/single polyp (>5mm) on an abdominal ultrasonography were included in the study. The patients then underwent either a triple phase CECT whole abdomen and pelvis or a MRI+MRCP abdomen. The patients were then divided into three groups:Group A- malignant and unresectable, Group B- malignant and resectable and Group C- USG/CECT findings were inconclusive/indeterminate for malignancy. All patients then underwent an ultrasound guided FNAC from the gallbladder wall/polyp/mass.
Results
A total of 94 patients with gallbladder wall thickening or polyp > 5mm or mass on ultrasound abdomen were included in the study from January, 2016 to August, 2021. Out of these, 28 patients were included in group A, 15 patients in group B and 51 patients in group C. The sensitivity and specificity of imaging was found to be 95% and 37% (95% CI) respectively. The positive predictive value and negative predictive value was found to be 39.6% and 94.4% respectively (95% CI). When FNAC was compared to final histopathology, the sensitivity and specificity of FNAC was 75% and 97.8% respectively (95% CI). The positive predictive value and negative predictive value of FNAC for malignancy was 93.8% and 98% respectively (95% CI). There were no needle tract seeding in any of the patients.
Conclusions
Preoperative USG guided FNAC adds to the diagnostic accuracy of imaging and prevents unnecessary radical procedure in patients who have a benign/inflammatory GB wall thickening without risk of needle tract seedings.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.