Early diagnosis of primary gallbladder cancer
He Xiaojun, Zhang Hongyi, Li Jielei, Zhang Hongyi, Zhang Xidong, Feng Zhiqiang
(Department of Hepatobiliary Surgery, Air Force General Hospital, Beijing 100036, China)
Abstract: The clinical data of 48 gallbladder cancer patients admitted to our hospital from 1 9 8 8 to 2 0 0 2 were retrospectively analyzed. The preoperative diagnosis in this group
The preoperative diagnosis rate was 8 5 . Among them, the diagnosis rate of early-stage gallbladder cancer was 12.5%. The preoperative diagnosis rate was 8 5 .1 %, among which the early diagnosis rate of gallbladder cancer was 1 2 .5 %, and the preoperative diagnosis rate of B-ultrasound and CT was 7 6 . 6 % and 8 5 . 2 %, He Xiaojun, Department of Hepatobiliary Surgery, Air Force General Hospital, Gastrointestinal Tract
Among the tumor markers, serum CA1 929 had the highest positivity rate ( 7 8 . 9 %). 6 2 . 5 % of gallbladder cancer combined with gallbladder stones, some patients were diagnosed with
Some patients were diagnosed with gallstone disease or acute cholecystitis and gallbladder cancer was discovered accidentally. Postoperative pathological adenocarcinoma was predominant (76%). The 5-year survival rate for early radical surgery for gallbladder cancer is 83 .
The 5-year survival rate of radical surgery for early-stage gallbladder cancer was 83 . The 5-year survival rate for advanced gallbladder cancer was 0.3%. It is suggested that ultrasound is the first choice for the diagnosis of primary gallbladder cancer, and the proper use of various examinations is the most important way to improve the survival rate of primary gallbladder cancer.
Ultrasound is the first choice for the diagnosis of primary gallbladder cancer, and the rational use of various tests is the basic way to improve the early diagnosis of primary gallbladder cancer; active cholecystectomy is recommended for high-risk gallbladder disease.
Keywords: P-diagnosis of gallbladder tumor; P-diagnosis of adenocarcinoma
CCS: R7 3 5 . 8 ; R7 3 0 . 2 6 1 Document ID:B
Primary gallbladder cancer has become a common malignant tumor in biliary surgery.
However, its early diagnosis rate is low. Once diagnosed, most of them are at advanced stages.
The literature reports that the 5-year survival rate after radical surgery for early-stage gallbladder cancer can reach 8 5 % to 9 1 %.
The survival rate after radical surgery for early-stage gallbladder cancer is reported to be 8.5%-9.1%, but less than 5% for advanced stage[1] . It is clear that early
diagnosis is an important part of improving the outcome of gallbladder cancer. In this paper, we summarize
In this paper, we summarized 48 cases of primary gallbladder cancer admitted to our hospital from 1988 to 2002.
In this paper, we summarized 48 cases of primary gallbladder cancer admitted to our hospital from 1988 to 2002, and focused on their early diagnosis.
1 Clinical data
1 . 1.1 General data
There were 27 male cases and 21 female cases in this group. Age 35 to 84 years old, 35 cases were 55 years old or older.
35 cases were above 55 years old, accounting for 72 . 9 %. Combined with gallbladder stones in 30 cases, accounting for 62 .
62 . 5 cases of malignant gallbladder polyps, accounting for 10.4%. 4 %. Gallbladder stones
The history of gallbladder stones ranged from 6 to 30 years, with an average of more than 10 years. The clinical manifestations of the patients were not clearly
The clinical manifestations of the patients were not specific. The main symptoms were abdominal pain, poor appetite, wasting, jaundice and abdominal mass.
The main symptoms included abdominal pain, poor appetite, lethargy, jaundice and abdominal mass, and three cases without any symptoms (Table 1).
1 . 2 Imaging examination
Forty-seven cases were diagnosed with gallbladder cancer by B-ultrasound, and 36 cases were diagnosed with the same diagnosis.
76 . 6 %. The image characteristics: thick wall type 11 cases, local mass type 16 cases, full type 6 cases, obstructive type 3 cases.
Among the 11 undiagnosed cases, 6 cases were diagnosed with gallbladder stones and 3 cases were diagnosed with obstruction.
Of the 11 undiagnosed cases, 6 were diagnosed with gallbladder stones and chronic cholecystitis, and 2 with acute cholecystitis,
Among the 11 undiagnosed cases, 6 were diagnosed with gallbladder stones and chronic cholecystitis, 2 with acute cholecystitis, 1 with gallbladder polyps, and 2 with bile duct cancer.
CT examination was performed in 27 cases, and gallbladder cancer was diagnosed in 23 cases, with a compliance rate of 85 . The rate of agreement was 85.2%. The imaging features were mass type7
Received:2002 – 07 – 18; Revised:2003 – 01 – 20.
He Xiaojun (1967 – ), male, from Suizhou, Hubei, China, is an attending physician at Beijing Air Force General Hospital.
He is a physician at Beijing Air Force General Hospital, mainly engaged in hepatobiliary research.
He is a physician at Beijing Air Force General Hospital.
Among the 12 cases, 5 cases had no gallbladder visualization, 3 cases had gallbladder visualization suggesting gallbladder cancer, 2 cases had bile duct obstruction, and 1 case had bile duct obstruction.
In one case, the bile duct was obstructed, and in one case, the bile duct was misdiagnosed.
stones.
Table 1 Clinical manifestations of 48 cases of gallbladder cancer
Percentage of clinical manifestations (%)
Abdominal pain 35 72.9
Poor appetite 23 47.9
Wasting 18 37.5
Jaundice 15 31. 3
Abdominal masses6 12. 5
Fever4 8. 3
Vomiting bloodP blood in stool2 4. 2
Cough1 2. 1
Dermatomyositis1 2. 1
Asymptomatic3 6. 3
1 . 3 Tumor marker measurement
The gastrointestinal tumor markers AFP , CEA , CA1929 , CA125 and CA153 were measured serologically in our patients with gallbladder cancer,
CA1929, CA125 and CA153 were measured serologically.
CA1929 had the highest positive rate ( 78 . The positive rate of CA1929 was the highest ( 78.9 %), and the measured values were greater than 3 times of the normal value.
The positive rate of CA1929 was the highest (78.9 %), and the measured values were greater than 3 times the normal value, which was significant.
The positive rate of CA125 was 50 %, while the positive rate of CA153 and AFP was less than 20 %. The positive rate of CA125 was 50%; the positive rate of CA153 and AFP was less than 20%.
The positive rate of CA125 was 50 %; the positive rate of CA153 and AFP was less than 20 %.
2 Results and follow-up
One case in this group died within 1 day of admission, and the diagnosis was not made, but the autopsy confirmed the diagnosis of
Gallbladder cancer was diagnosed at autopsy. The preoperative diagnosis rate was 85 . 1 % ( 40P47 ); postoperative pathology confirmed
7 cases were diagnosed postoperatively. There were only 6 cases of stage I and II gallbladder cancer and 32 cases of stage IV and V cancer.
Vol. 12, No. 2
February 2003
Chinese Journal of General Surgery
Chinese Journal of General Surgery
Vol . 12 No. 2 12 No. 2
Feb. 2003
Of the 48 cases, 19 cases were inoperable due to poor general condition with other important organ
The patients were inoperable due to poor general condition, other important organ dysfunction and extensive metastasis; 29 cases were treated surgically, 14 cases were treated radically and 14 cases were treated with palliative bile-intestinal anastomosis.
Of these, 14 were radical surgery, 11 were palliative bile-intestinal anastomosis with T-tube drainage, and 11 were intra-biliary stent drainage.
In 29 cases, radical surgery was performed in 14 cases, palliative bile-intestinal anastomosis with T-tube drainage in 11 cases, endobiliary stent drainage in 3 cases, and percutaneous hepatobiliary duct in 1 case. Tumor
The resection rate of tumor was 48%. Postoperative pathology: 22 cases of adenocarcinoma, 1 case of squamous carcinoma,
One case of small cell carcinoma and five cases of adenoma malignancy. All 28 cases were followed up.
The 1-year survival rate of all patients with advanced gallbladder cancer was 21 . All patients with advanced gallbladder cancer had a 1-year survival rate of 21.9% (7P32) and a 5-year survival rate of 0.
The 5-year survival rate for early-stage gallbladder cancer with radical surgery was 83.3 % (5P6).
(5P6).
3 DISCUSSION
Primary gallbladder cancer is insidious, non-specific, and often associated with cholecystitis, cholelithiasis, and cholestasis.
It often coexists with cholecystitis, cholelithiasis and gallbladder polyps. The clinical manifestations are divided into four major syndromes
The clinical manifestations are divided into four major syndromes: ( 1 ) acute cholecystitis manifestations, such as transient
The clinical manifestations are divided into four major syndromes: ( 1 ) acute cholecystitis, such as transient right upper abdominal pain with nausea, vomiting and fever.
B ultrasound shows enlarged gallbladder with bilateral signs and gallstones in combination. This kind of presentation
This kind of presentation often affects the judgment of the thickness of the gallbladder wall by ultrasound and is easily misdiagnosed.
In our group, 12.5% of the patients had this as the first symptom. In our group, this was the first symptom in 12.5% of cases. ( 2 ) Chronic cholecystitis
The manifestations of chronic cholecystitis, such as epigastric discomfort, chronic dyspepsia, and even wasting, are the most common symptoms of gallbladder cancer.
This is the most common symptom of gallbladder cancer. These cases often have a long history of gallbladder stones.
history of gallbladder stones, which is easily misdiagnosed clinically, and is often diagnosed only when liver metastases or jaundice are present.
The diagnosis is often confirmed when liver metastases or jaundice appear. In our group, the preoperative leakage and misdiagnosis rate was as high as 25.5%. ( 3 ) Biliary tract
The malignant tumor manifestation, such as jaundice, wasting, persistent pain in the right quadrant of the rib cage,
( 3 ) The manifestations of malignant tumor in the biliary tract, such as jaundice, emaciation, persistent pain in the right quadrant, or palpable mass, are advanced manifestations of gallbladder cancer. This group accounted for
31.3 %. ( 4) Extra-biliary manifestations, a few cases were characterized by weight loss, general weakness or invasion of adjacent organs.
(4) Extra-biliary manifestations, a few cases presented with weight loss, general debility or symptoms of invasion of adjacent organs.
The four cases in this group had hepatic coma, hematemesis, pneumonia with pleural fluid or dermatomyositis as the first symptoms.
The four cases in this group had liver coma, vomiting blood, pneumonia with pleural fluid or dermatomyositis as the first symptoms, accounting for 8.3%. The four cases in this group had liver coma, vomiting blood, pneumonia with pleural fluid or dermatomyositis as the first symptoms, accounting for 8.3%. However, it is difficult to use the above symptoms as a basis for early diagnosis of gallbladder cancer.
However, these manifestations could not be used as a basis for early diagnosis of gallbladder cancer, and some cases were asymptomatic. Therefore
Therefore, close attention should be paid to high-risk groups.
According to Wu Gang[2] , B ultrasound is the first choice for biliary tract diseases.
According to Wu Gang,[2] B ultrasound is the first choice for biliary disease and can directly observe the morphology of the gallbladder; the location of stones and masses, their size and the presence of metastases and ascites.
B ultrasound is the first choice for biliary tract disease, and can directly visualize gallbladder morphology; the location, size, and presence of metastases and ascites. The diagnostic rate is 75-89%. B
The diagnostic rate of ultrasound in our group is 76 . The diagnostic rate of ultrasound in our group was 76.6%, and the image characteristics were thick-walled, localized masses, filled and obstructed.
The image characteristics were mainly thick-walled, localized masses, fullness and obstruction. The main reason for the misdiagnosis was that the examiners were only satisfied with
The main reason for misdiagnosis is that the examiners are satisfied with the diagnosis of gallbladder stones, cholecystitis or gallbladder polyps,
The main reason for misdiagnosis is that the examiner is satisfied with the diagnosis of gallbladder stones, gallbladder
The relationship between the gallbladder and the surrounding organs was not carefully observed. The authors concluded that regular ultrasound examinations should be performed in people over 55 years of age.
B ultrasound should be performed regularly in people over 55 years of age, and early stage gallbladder cancer should be highly suspected if one of the following conditions occurs
(1) Irregular shape of the gallbladder and limited thickening of the gallbladder wall;
( 2) the detection of occupying lesions in the gallbladder that do not move with body position; ( 3) the recent appearance of polyps in long-term gallbladder stones
( 3 ) Long-term gallbladder stones with recent polypoid lesions; ( 4 ) Solitary gallbladder
polypoid lesion with diameter > 1 . ( 5 ) Gallbladder stone filled type or
( 6) Porcelain gallbladder.
The diagnosis rate of early gallbladder cancer by B ultrasound is not high, and it is easily interfered by obesity and gastric and intestinal gas.
(6) porcelain gallbladder. Niu Yanling[3] reported that the use of ultrasound endoscopy (EUS)
The origin of the lesion is not related to the wall of the gallbladder,
The relationship between the origin of the lesion and the gallbladder wall is of great value for the diagnosis of early stage gallbladder cancer.
It is of great value in the diagnosis of early gallbladder cancer. Color Doppler has also been used to observe the blood flow in the lesion,
The RI of arterial flow resistance index (RI) has been used to distinguish benign and malignant gallbladder lesions.
It is also used to observe the blood flow in the lesion by color Doppler and measure the arterial resistance index (RI) to distinguish benign and malignant gallbladder lesions and improve the early diagnosis of gallbladder cancer[4] .
CT is less sensitive than B-ultrasound in detecting small bulge-like lesions in the gallbladder.
However, it can better show the anatomical relationship between the gallbladder and adjacent organs, the degree of tumor infiltration and metastasis.
The CT examination is less sensitive than B ultrasound in detecting small bulging lesions of the gallbladder, but it can better show the anatomical relationship between the gallbladder and adjacent organs, the degree of tumor infiltration and metastasis, and provide a basis for the choice of surgical
However, it can better show the anatomical relationship between the gallbladder and adjacent organs, the degree of tumor infiltration and metastasis, and provide a basis for the choice of surgical procedure. The diagnosis rate of gallbladder cancer by CT in our group was 85.2%.
The main manifestations were: ( 1) limited or extensive irregular thickening of the gallbladder wall,
Most of them exceeded 0.6 cm. ( 1) limited or widespread irregular thickening of the gallbladder wall, mostly more than 0.6 cm, and obvious enhancement of the gallbladder wall after enhancement; ( 2) gallbladder cavity
( 2) intracavitary > 1 . ( 2) nodules > 1.0 cm in the cavity of the gallbladder, with the base of the nodules showing unequal width on enhancement; ( 3)
( 3) Irregular hypodense mass in the gallbladder fossa area, and the gallbladder structure is not clearly shown;
( 4) solid gallbladder with invasion of the square lobe of the liver; ( 5) confluence of the three bile ducts
( 6 ) hepatoduodenal ligament and retroperitoneal lymph node metastasis.
More than half of the patients with gallbladder cancer on ERCP cannot show the gallbladder.
The gallbladder is not visualized. If the gallbladder is visualized, small bulging lesions within the gallbladder can be detected, as well as their size and
If the gallbladder is visualized, small bulging lesions in the gallbladder can be detected, as well as their size and shape, which can be helpful for early diagnosis of gallbladder cancer.
ERCP can also take bile for cytological examination and tumor marker determination.
It is important to improve the early diagnosis of gallbladder cancer [5].
It is important to improve the early diagnosis of gallbladder cancer[5] .
There are no specific markers for primary gallbladder cancer. In our group
In the screening of tumor markers performed by our group, the positive rate of serum CA1929 in gallbladder cancer was 78.5%.
The highest positive rate was 78 . In the screening of tumor markers performed by our group, the highest positive rate of CA1929 was 78.9 %, and the positive rate of CA125 was 50 %.
The positive rate of CA1929 and CA125 was 78.9 % and 50 %, respectively, and the confirmation rate of CA125 was 100 % and 83 .
83 . The positive rate of CA125 was 50 %, and the confirmation rate was 100 % and 83 .
It is useful to identify benign and malignant gallbladder lesions. The detection rate of CA1929 in bile of gallbladder cancer was reported to be higher than that of blood.
The detection rate of CA1929 in the bile of gallbladder cancer was reported to be higher than that of serum, reaching 80 to 85 %, which is more
It is reported that the rate of CA1929 detection in bile of gallbladder cancer is higher than that of serum and can reach 80- 85%, which indicates that it is useful for the early diagnosis of gallbladder cancer[5] .
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