ULTRASOUND IN THE DIAGNOSIS OF GALLBLADDER CARCINOMA IN CHINESE PATIENTS

A review of the ultrasound (US) findings with clinical and pathologica l correlation in 18 Chinese patients with gall-bladder carcinoma (GBCa ) showed that the most frequent appearance was that of diffuse infiltr ation and thickening of the GB wall (8/18 patients, 44%). Polypoid pro trusion into the GB lumen (5/18 patients, 28%) and massive replacement of the entire GB (5/18 patients, 28%) accounted for the remainder. Th e infiltrating type of tumour was poorly-detected by US (1/8) and was more frequently seen than has been reported in the Western population. Frequent associations with GB calculi (13/18) and synchronous present ation of biliary sepsis (6/18) also contributed to a modest overall US detection rate of 50% (9/18) in this series. Most tumours detected by US were hyperechoic in appearance (6/9). Biliary obstruction was dete cted by US in 5/6 patients, but only thought to be malignant in 3/6. I t most often occurred due to spread of tumour to peripancreatic lymph nodes. Hepatic metastases were seen by US in 4/5 patients. Discontinuo us GB wall calcification and non-dependent stones due to elevation by tumour (the 'elevated stone' sign) were infrequent but reliable signs of GBCa, seen in 5/18 and 3/18 respectively. This study suggests that GBCa is as difficult to detect sonographically in Chinese patients as in the Western population. GBCa must be included in the differential d iagnosis of causes of both the acutely-presenting 'hot' gall-bladder a nd lymph node masses in the peripancreatic region if the US detection rate of this important biliary malignancy is to be improved.