Value of contrast-enhanced ultrasound in differentiating benign and malignant gallbladder lesions which diameter more than 1 cm

doi:10.16139/j.1007-9610.2023.06.012

Abstract

Abstract:

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder lesions which diameter more than 1 cm. Methods A retrospective analysis included CEUS data of 142 cases with gallbladder lesions diameter more than 1 cm. All lesions were confirmed by surgical pathology, enhanced CT/MRI or clinical diagnosis with following up more than 2 years. To summarize the CEUS characteristics of benign and malignant gallbladder lesions over 1 cm in diameter, the CEUS characteristics of benign and malignant gallbladder lesions diameter more than 1 cm were analyzed, referring to the gallbladder CEUS guidelines. The contrast medium washout before 35 s and 60 s were used as the combined diagnosis with CEUS standard to identify gallbladder cancer, and the diagnostic efficiency was calculated respectively. Results There were statistical differences between the malignant group and the benign group in terms of CEUS enhancement pattern, contrast arrival time, washout time, and gallbladder wall continuity, as well as enhancement levels (P<0.001). The sensitivity, specificity, accuracy in the diagnosis of gallbladder malignant lesions were 93.0%, 83.8%, and 86.6% based on CEUS standard. The sensitivity, specificity and accuracy of diagnosis gallbladder malignant lesions were increased to 93.0%, 92.9% and 93.0% when combined with washout before 35 s of contrast medium. Conclusions CEUS is highly valuable in differentiating benign and malignant gallbladder lesions diameter more than 1 cm. Combined with contrast medium washout before 35 s is helpful to improve the ability of differentiating benign and malignant gallbladder lesions.

Key words: Contrast-enhanced ultrasound, Gallbladder lesions, Gallbladder cancer, Enhancement pattern, Differential diagnosis

CLC Number:

FENG Meijing, REN Xinping, ZHAN Weiwei, ZHENG Lili, LI Junjian. Value of contrast-enhanced ultrasound in differentiating benign and malignant gallbladder lesions which diameter more than 1 cm[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 556-562.

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References 22

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Characteristics	Malignant lesions (n=43)	Benign lesions (n=99)	Test statistic value	P value
Gross type (n/%)			χ²=56.480	<0.001
Mass type	9(20.9)	85(85.9)
Thick-walled type	34(79.1)	14(14.1)
Characteristic
Diameter (mm) M(IQR)	32.0(20.0)	15.5(14.0)	Z=5.522	<0.001
Quantity (n/%)			χ²=15.089	<0.001
Single shot	29(67.4)	32(32.3)
Multiple	14(32.6)	67(67.7)
Form(n/%)			χ²=36.776	<0.001
Rule	12(27.9)	80(80.8)
Irregularity	31(72.1)	19(19.2)
Echo (n/%)			χ²=14.529	0.002
Hyperechoic	12(27.9)	49(49.5)^a)
Hypoechoic	10(23.3)	4(4.0) ^a)
Isoechoic	14(32.6)	30(30.3)
Mixed echoic	7(16.3)	16(16.2)
Gallbladder wall (n/%)			χ²=0.320	0.572
Thickening	16(37.2)	32(32.3)
No thickening	27(62.8)	67(67.7)
Gallbladder and liver boundary (n/%)			χ²=38.523	<0.001
Clear	21(48.8)	93(93.9)
Unclear	22(51.2)	6(6.1)
Gallstone (n/%)				0.553
Yes	3(7.0)	12(12.1)
No	40(93.0)	87(87.9)

Characteristics of CEUS	Malignant lesions (n=43)	Benign lesions (n=87)	Test statistic value	P value
Enhancement patterns (n/%)			χ²=30.658	<0.001
Homogeneously	8(18.6)	61(70.1)
Heterogeneously	35(81.4)	26(29.9)
Enhancement level (n/%)			χ²=22.132	<0.001
Hyperenhancement	33(76.8)	30(34.5)^a)
Isoenhancement	5(11.6)	14(16.1)
Hypo-enhancement	5(11.6)	43(49.4)^a)
Contrast arrival time(s) M(IQR)	15(6)	18(6)	Z=10.753	<0.001
Contrast washout time(s) M(IQR)	45(29)	64(40)	Z=3.794	<0.001
Wall continuity (n/%)			χ²=41.611	<0.001
Continuity	18(41.9)	81(93.1)
Discontinuity	25(58.1)	6(6.8)

Gold standard	CEUS standard		CEUS standard combined with contrast medium washout before 60 s		CEUS standard combined with contrast medium washout before 35 s
Gold standard	Malignant	Benign	Malignant	Benign	Malignant	Benign
Malignant	40	3	42	1	40	3
Benign	16	83	40	59	7	92
κ value	0.708		0.456		0.837

Diagnostic effectiveness	CEUS standard	CEUS standard combined with contrast medium washout before 60 s	CEUS standard combined with contrast medium washout before 35 s
Sensitivity	93.0	97.7	93.0
Specificity	83.8	59.6	92.9
Positive predictive value	71.4	51.2	85.1
Negative predictive value	96.5	98.3	96.8
Accuracy	86.6	71.1	93.0