Ultrasound criteria for sessile elevated early gallbladder carcinoma

What is it about?

Ultrasound criteria for sessile elevated early gallbladder carcinoma (GBC) are described. Early GBC is divided into T1a carcinoma or T1b carcinoma, confined to the mucosa or muscle layer. The ultrasound image of T1b carcinoma differs between protruded and flat-elevated lesions. A protruded lesion with a conically thickened outermost hyperechoic layer but without a deep hypoechoic area corresponds to T1b carcinoma. In contrast, a flat-elevated lesion without a conically thickened outermost hyperechoic layer and a deep hypoechoic area corresponds to T1a or T1b carcinoma.

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Photo by Boris Smokrovic on Unsplash

Photo by Boris Smokrovic on Unsplash

Why is it important?

Those with neither a thinned nor a split outermost hyperechoic layer are confined to the mucosa or muscle layer (T1 carcinoma) or invaded only the shallow subserosal fibrous layer adjacent to the muscle coat (subserosal fibrous layer). Although differentiation of these latter two types posed issues, a deep hypoechoic area is helpful because ultrasound and pathological correlation shows that a deep hypoechoic area represents an adenocarcinoma invading subserosa accompanied by abundant fibrosis and lymphocytic infiltration.

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