TY - JOUR
T1 - Preoperative diagnostic failure in gallbladder cancer
T2 - influence of tumor location and size on imaging precision
AU - Akabane, Miho
AU - Kawashima, Jun
AU - Altaf, Abdullah
AU - Woldesenbet, Selamawit
AU - Aucejo, Federico
AU - Kitago, Minoru
AU - Imaoka, Yuki
AU - Ruzzenente, Andrea
AU - Endo, Itaru
AU - Marques, Hugo P.
AU - Lam, Vincent
AU - Maithel, Shishir K.
AU - Hugh, Tom
AU - Bhimani, Nazim
AU - Pawlik, Timothy M.
PY - 2025/7
Y1 - 2025/7
N2 - Background: Preoperative imaging diagnosis of early-stage gallbladder cancer (GBC) remains challenging. The effectiveness of different imaging modalities and clinical factors to diagnose GBC have not been fully investigated. We identified risk factors for preoperative diagnostic failure of GBC, including tumor location (hepatic vs. peritoneal) and size relative to different imaging approaches. Methods: Patients undergoing curative-intent GBC resection (2000-2023) were identified from an international, multi-institutional database. The primary outcome was successful preoperative GBC diagnosis based solely on imaging without biopsy. Multivariable logistic regression identified risk factors associated with diagnostic failure, and the impact of different imaging modalities was assessed. Results: Among 293 patients, preoperative GBC diagnosis was successfully made in 164 (56.0 %) patients. Hepatic-sided tumors were less common among undiagnosed versus diagnosed patients (18.6 % vs. 44.5 %; p = 0.033). On multivariable analysis, hepatic-sided location (OR:0.13 [0.02-0.76]; p = 0.025, ref:peritoneal-sided) and tumor size >= 2.0 cm (OR:0.11 [0.01-0.88]; p = 0.035) were associated with lower odds of preoperative imaging diagnostic failure. Among tumors <2.0 cm, peritoneal-sided lesions had a higher risk of diagnostic failure than hepatic-sided, with the risk gap widening as size decreased. MRI/MRCP (39.5 % vs. 65.2 %) and EUS (5.4 % vs. 16.5 %) were used less often among undiagnosed patients compared to diagnosed ones (both p < 0.001), while CT use was similar (84.5 % vs. 85.4 %; p = 0.993). The failure of preoperative imaging diagnosis decreased as more imaging modalities were combined compared with CT alone: 65.1 % for CT only versus 17.4% for CT plus MRI/MRCP or EUS. Conclusion: Peritoneal-sided tumors and lesions <2.0 cm were associated with higher preoperative diagnostic failure risk among patients with GBC, especially when a single imaging modality was utilized. Combining different imaging modalities may improve preoperative diagnosis among this subset of patients.
AB - Background: Preoperative imaging diagnosis of early-stage gallbladder cancer (GBC) remains challenging. The effectiveness of different imaging modalities and clinical factors to diagnose GBC have not been fully investigated. We identified risk factors for preoperative diagnostic failure of GBC, including tumor location (hepatic vs. peritoneal) and size relative to different imaging approaches. Methods: Patients undergoing curative-intent GBC resection (2000-2023) were identified from an international, multi-institutional database. The primary outcome was successful preoperative GBC diagnosis based solely on imaging without biopsy. Multivariable logistic regression identified risk factors associated with diagnostic failure, and the impact of different imaging modalities was assessed. Results: Among 293 patients, preoperative GBC diagnosis was successfully made in 164 (56.0 %) patients. Hepatic-sided tumors were less common among undiagnosed versus diagnosed patients (18.6 % vs. 44.5 %; p = 0.033). On multivariable analysis, hepatic-sided location (OR:0.13 [0.02-0.76]; p = 0.025, ref:peritoneal-sided) and tumor size >= 2.0 cm (OR:0.11 [0.01-0.88]; p = 0.035) were associated with lower odds of preoperative imaging diagnostic failure. Among tumors <2.0 cm, peritoneal-sided lesions had a higher risk of diagnostic failure than hepatic-sided, with the risk gap widening as size decreased. MRI/MRCP (39.5 % vs. 65.2 %) and EUS (5.4 % vs. 16.5 %) were used less often among undiagnosed patients compared to diagnosed ones (both p < 0.001), while CT use was similar (84.5 % vs. 85.4 %; p = 0.993). The failure of preoperative imaging diagnosis decreased as more imaging modalities were combined compared with CT alone: 65.1 % for CT only versus 17.4% for CT plus MRI/MRCP or EUS. Conclusion: Peritoneal-sided tumors and lesions <2.0 cm were associated with higher preoperative diagnostic failure risk among patients with GBC, especially when a single imaging modality was utilized. Combining different imaging modalities may improve preoperative diagnosis among this subset of patients.
KW - Diagnosis
KW - Gallbladder carcinoma (GBC)
KW - Imaging
KW - Peritoneal
KW - Size
KW - Tumor location
UR - http://www.scopus.com/inward/record.url?scp=105000499087&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2025.109979
DO - 10.1016/j.ejso.2025.109979
M3 - Article
C2 - 40121747
SN - 0748-7983
VL - 51
SP - 1
EP - 7
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 7
M1 - 109979
ER -