Radio-pathological Correlation of 18F-FDG PET in Characterizing Gallbladder Wall Thickening

• Published in: Journal of gastrointestinal cancer 2019-12, Vol.50 (4), p.901-906
• Main Authors: Gupta, Vikas, Vishnu, K. S., Yadav, Thakur D., Sakaray, Yashwant R., Irrinki, Santosh, Mittal, B. R., Kalra, N., Vaiphei, K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cancer Research; Cholecystectomy; Cholecystitis - diagnosis; Cholecystitis - pathology; Cholecystitis - surgery; Diagnosis, Differential; Female; Fluorodeoxyglucose F18 - administration & dosage; Gallbladder - diagnostic imaging; Gallbladder - pathology; Gallbladder - surgery; Gallbladder Neoplasms - diagnosis; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Gastroenterology; Humans; Internal Medicine; Lymph Nodes - diagnostic imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Research; Positron-Emission Tomography - methods; Prospective Studies; Radiopharmaceuticals - administration & dosage; Radiotherapy; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography; Young Adult
• ISSN: 1941-6628; 1941-6636
• DOI: 10.1007/s12029-018-0176-2

Aim Thick-walled gallbladder is difficult to characterize on conventional imaging. 18F-FDG PET was used to differentiate benign and malignant wall thickness and compared with histopathology. Methods Thirty patients with gallbladder (GB) wall thickening (focal > 4 mm and diffuse > 7 mm), underwents uspected on  ultrasound, or CT scan, and underwent 18F-FDG PET. Histopathology of the specimen was compared with imaging findings. Results The mean age was 48.22 ± 31.33 years with a M:F 1:4 ratio. Twenty patients had diffuse and 10 had focal thickening. On 18F-FDG PET, lesion was benign in 12, malignant in 13, and indeterminate in 5. Histopathology was malignancy in 12; benign in 18-chronic cholecystitis in 11, xanthogranulomatous in 4, IgG4 related in 2, and polyp in 1. The mean GB wall thickness was 7.79 ± 3.59 mm (10.34 malignant and 6.10 in benign, p  = 0.001). At a cutoff of 8.5 mm, the sensitivity and specificity of detecting malignancy was 94% and 67%. The mean SUV uptake was 7.46 (benign 4.51, malignant 14.26, p  = 0.0102). At a cutoff of 5.95, the sensitivity and specificity of detecting malignancy was 92% and 79%. For 18F-FDG PET, overall sensitivity was 91%, specificity 79%, PPV 77%, NPV 92%, and diagnostic accuracy was 84%. Conclusion 18F-FDG PET is a reliable method of differentiation between benign and malignant thickening of the gallbladder particularly when wall thickness and SUV value is taken into account.