Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan, China.
World J Gastroenterol. 2009 Dec 7;15(45):5662-8. doi: 10.3748/wjg.15.5662.
To compare clinical presentation and ultrasound (US) and computed tomography (CT) sensitivity between intraluminal and infiltrating gallbladder carcinoma (GBCA).
This retrospective study evaluated 65 cases of GBCA that were categorized morphologically into the intraluminal-GBCA (n = 37) and infiltrating-GBCA (n = 28) groups. The clinical and laboratory findings, presence of gallstones, gallbladder size, T-staging, nodal status, sensitivity of preoperative US and CT studies, and outcome were compared between the two groups.
There were no significant differences between the two groups with respect to female predominance, presence of abdominal pain, serum aminotransferases level, T2-T4 staging, and regional metastatic nodes. Compared with the patients with intraluminal-GBCA, those with infiltrating-GBCA were significantly older (65.49 +/- 1.51 years vs 73.07 +/- 1.90 years), had a higher frequency of jaundice (3/37 patients vs 13/28 patients) and fever (3/37 patients vs 10/28 patients), higher alkaline phosphatase (119.36 +/- 87.80 IU/L vs 220.68 +/- 164.84 IU/L) and total bilirubin (1.74 +/- 2.87 mg/L vs 3.50 +/- 3.51 mg/L) levels, higher frequency of gallstones (12/37 patients vs 22/28 patients), smaller gallbladder size (length, 7.47 +/- 1.70 cm vs 6.47 +/- 1.83 cm; width, 4.21 +/- 1.43 cm vs 2.67 +/- 0.93 cm), and greater proportion of patients with < 12 mo survival (16/37 patients vs 18/28 patients). The sensitivity for diagnosing intraluminal-GBCA with and without gallstones was 63.6% and 91.3% by US, and 80% and 100% by CT, respectively. The sensitivity for diagnosing infiltrating-GBCA with and without gallstones was 12.5% and 25% by US, and 71.4% and 75% by CT, respectively.
In elderly women exhibiting small gallbladder and gallstones on US, especially those with jaundice, fever, high alkaline phosphatase and bilirubin levels, CT may reveal concurrent infiltrating-GBCA.
比较腔内型和浸润型胆囊癌（GBCA）的临床表现、超声（US）和计算机断层扫描（CT）的敏感性。
本回顾性研究对 65 例 GBCA 进行了形态学分类，分为腔内型 GBCA（n=37）和浸润型 GBCA（n=28）组。比较两组间的临床和实验室检查、胆囊结石、胆囊大小、T 分期、淋巴结状态、术前 US 和 CT 检查的敏感性及预后。
两组间女性优势、腹痛、血清转氨酶水平、T2-T4 分期和区域转移性淋巴结无显著差异。与腔内型 GBCA 患者相比，浸润型 GBCA 患者年龄更大（65.49±1.51 岁 vs 73.07±1.90 岁），黄疸（3/37 例 vs 13/28 例）和发热（3/37 例 vs 10/28 例）发生率更高，碱性磷酸酶（119.36±87.80IU/L vs 220.68±164.84IU/L）和总胆红素（1.74±2.87mg/L vs 3.50±3.51mg/L）水平更高，胆囊结石发生率（12/37 例 vs 22/28 例）更高，胆囊较小（长度：7.47±1.70cm vs 6.47±1.83cm；宽度：4.21±1.43cm vs 2.67±0.93cm），<12 个月生存率更高（16/37 例 vs 18/28 例）。US 诊断有和无胆囊结石的腔内型 GBCA 的敏感性分别为 63.6%和 91.3%，CT 分别为 80%和 100%。US 诊断有和无胆囊结石的浸润型 GBCA 的敏感性分别为 12.5%和 25%，CT 分别为 71.4%和 75%。
在 US 显示小胆囊和胆囊结石的老年女性中，尤其是有黄疸、发热、高碱性磷酸酶和胆红素水平者，CT 可能发现并存的浸润型 GBCA。
