ROLE OF PET CT IN GALL BLADDER CANCER-A META ANALYSIS

Abstract

Introduction: Primary gall bladder carcinoma is a rare cancer, however it is one of the most prevalent bile system cancers. Cholelithiasis is the most frequent risk factor for the development of gallbladder carcinoma worldwide, with a varying incidence of gallbladder carcinoma across geographic areas due to cholelithiasis prevalence. Gallbladder cancer is one of the most common cancers in the Gangetic and Brahmaputra valleys of Northern and Eastern India. Gallbladder cancer is identified preoperatively in less than 20% of instances, while the remaining cases are diagnosed intraoperatively or after laparoscopic cholecystectomy in 74-92% of cases. Materials and Methods: A search was conducted using the following terms: gallbladder cancer; gallbladder neoplasms; cholangiocarcinoma; bile duct cancer; PET; positron emission tomography. The search was conducted separately by two authors (SS, BM) using the PRISMA statement's verified techniques. There were no language restrictions. MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, Scopus, Doaj, Cochrane and Web of Science were the databases analysed. To identify further relevant studies, the reference lists of all included papers, as well as related review articles, were manually searched.
Results: Seven studies examined the role of PET-CT in gallbladder carcinoma though two studies did not report their results specifically. Butte et al investigated 32 patients with incidental gallbladder carcinoma following laparoscopic cholecystectomy. Thirteen patients had negative PET-CT results, 9 refused further resection with only one of the four patients resected having residual disease on operative exploration. PET-CT changed management in 12 out of 32 patients (38%) demonstrating unexpected disseminated disease in 10 patients and localised resectable disease in 2 patients.
Conclusion: 230 records were screened, 49 were assessed and 7 studies were included in the systematic review. PET-CT has a low sensitivity for regional lymph node metastases from cholangiocarcinoma and gallbladder cancer but a high specificity. In one study, PET-CT appears to be effective in assessing all nodal basins related to the liver, bile ducts and gallbladder. PET-CT has no role in the assessment of hepatic satellite lesions but is useful in defining extraabdominal metastatic disease and recurrent disease and to assess specific areas of concern defined on CT scan and/or magnetic resonance scan.