How can we identify T1 or shallow T2 gallbladder carcinoma using ultrasound?

What is it about?

Ultrasound criteria for T1 or shallow T2 gallbladder carcinoma (GBC) are described. A protruded lesion without a deep hypoechoic area but with a conically thickened outermost hyperechoic layer corresponds to T1b carcinoma. In contrast, a protruded lesion with both a deep hypoechoic area and a conically thickened outermost hyperechoic layer corresponds to shallow T2 carcinoma (subserosal invasion depth ≤ 2 mm). A deep hypoechoic area represents an adenocarcinoma invading subserosa, accompanied by abundant fibrosis and lymphocytic infiltration, regardless of the characteristics of the outermost hyperechoic layer. Furthermore, the presence of a deep hypoechoic area is more significant than a thinned nor a split outermost hyperechoic layer in diagnosing the depth of carcinoma invasion. The differential diagnosis between malignant and benign gallbladder tumors using contrast-enhanced ultrasound (CEUS) is effective. However, there are no established CEUS criteria for the preoperative assessment of GBC invasion depth, specifically for T2 GBC. Therefore, CEUS may not offer substantial information for surgical planning.

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Photo by Vincent van Zalinge on Unsplash

Photo by Vincent van Zalinge on Unsplash

Why is it important?

Patients with early (T1) GBC have a good postoperative prognosis. Furthermore, radical resection provides a favorable prognosis for patients with shallow T2 GBC.

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