STAGING OF CARCINOMA OF THE GALLBLADDER - AN ULTRASONOGRAPHIC EVALUATION

Background/Aims: Preoperative staging of carcinoma of the gallbladder is important in choosing the most appropriate treatment modality. Ultr asonography is commonly used for the diagnosis of carcinoma of the gal lbladder, but its role in staging of the disease has not been adequate ly evaluated. The aim of this study was to prospectively evaluate the role of ultrasonography performed by a single operator in the staging of carcinoma of the gallbladder. Methodology: Twenty-six patients with carcinoma of the gallbladder were evaluated in, this study. Ultrasono graphic staging was done by a single senior radiologist and compared w ith surgical staging using the AJCC TNM staging system. A retrospectiv e evaluation was done of 122 operated patients with carcinoma of the g allbladder, and the findings were compared to the results of the prosp ective study. Results: In the prospective study, the overall accuracy of ultrasonography in correctly staging the disease was 38% (10/26). O nly 1 patient was overstaged, while the majority of patients were unde rstaged (15) due to missed distant metastasis (10) and missed advanced Local infiltration (5). The sensitivity in detecting liver infiltrati on was 50%; lymph node metastasis, 50%; and liver metastasis, 8%. In t he retrospective study, the similar detection rates were 27%, 25% and 10%, respectively. Conclusion: Real time ultrasonography has been foun d to have inherent limitations in staging carcinoma of the gallbladder . Its accuracy, though improved in a prospective study, is inadequate in staging the disease accurately. More accurate imaging modalities ar e therefore required to accurately stage the disease preoperatively, s o as to avoid unnecessary laparotomies.