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European Radiology
Published in: European Radiology 12/2019

01-12-2019 | Computed Tomography | Gastrointestinal

Preoperative CT findings for prediction of resectability in patients with gallbladder cancer

Authors: Seo-Youn Choi, Jung Hoon Kim, Hyun Jeong Park, Joon Koo Han

Published in: European Radiology | Issue 12/2019

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Abstract

Objectives

To predict residual tumor (R) classification in patients with a surgery for gallbladder (GB) cancer, using preoperative CT.

Methods

One hundred seventy-three patients with GB cancer who underwent CT and subsequent surgery were included. Two radiologists assessed CT findings, including tumor morphology, location, T stage, adjacent organ invasion, hepatic artery (HA) invasion, portal vein invasion, lymph node metastasis, metastasis, resectability, gallstone, and combined cholecystitis. The R classification was categorized as no residual tumor (R0) and residual tumor (R1 or R2). We analyzed the correlation between CT findings and R classification. We also followed up the patients as long as five years and analyzed the relationship between the R classification and the overall survival (OS).

Results

There were 134 patients with R0 and 39 patients with R1/R2. On multivariable analysis, liver invasion (Exp(B) = 3.19, p = 0.010), bile duct invasion (Exp(B) = 3.69, p = 0.031), and HA invasion (Exp(B) = 3.74, p = 0.039) were independent, significant predictors for residual tumor. When two of these three criteria were combined, the accuracy for predicting a positive resection margin was 83.38% with a specificity of 93.28%. The OS and the median patient survival time differed significantly according to the resection margin, i.e., 56.0% and 134.4 months in the R0 resection and 5.1% and 10.8 months in the R1/R2 resection group (p < 0.001).

Conclusions

Preoperative CT findings could aid in planning surgery and determining the resectability using the high-risk findings of residual tumor, including liver invasion, bile duct invasion, and HA invasion.

Key Points

• Liver invasion, bile duct invasion, and HA invasion were significant preoperative CT predictors for residual tumor in GB cancer.
• HA invasion showed the highest OR on multivariate analysis and the highest predictor point on a nomogram for predicting a positive resection margin.
• Association of two factors can predict positive resection margin with an accuracy of 83.38% and a specificity of 93.28%.
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Metadata
Title
Preoperative CT findings for prediction of resectability in patients with gallbladder cancer
Authors
Seo-Youn Choi
Jung Hoon Kim
Hyun Jeong Park
Joon Koo Han
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 12/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06323-4

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