Locally advanced gallbladder cancer: a review of the criteria and role of imaging
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REVIEW
Locally advanced gallbladder cancer: a review of the criteria and role of imaging Pankaj Gupta1 · Kesha Meghashyam1 · Yashi Marodia1 · Vikas Gupta2 · Rajender Basher3 · Chandan Krushna Das4 · Thakur Deen Yadav2 · Santhosh Irrinki2 · Ritambhra Nada5 · Usha Dutta6 Received: 10 July 2020 / Revised: 26 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Gallbladder carcinoma (GBC) is among one of the gastrointestinal malignancies with extremely dismal prognosis. This is due to the advanced stage at presentation. Majority of the patients with GBC are not considered candidates for surgery because of the locally advanced disease or metastases. However, with the accumulating evidence regarding the role of neoadjuvant chemotherapy, there is a need to correctly identify a subset of patients with locally advanced GBC who will benefit maximally from neoadjuvant chemotherapy and will be successfully downstaged to receive curative (R0) surgery. In this context, there is a lack of consensus and different groups have resorted to criteria for locally advanced disease eligible for neoadjuvant chemotherapy based on personal or institutional experiences. Imaging plays a critical role in the evaluation of patients with GBC as it helps stratify patients into resectable and unresectable. Imaging also has the potential to identify patients with locally advanced GBC and hence facilitate neoadjuvant chemotherapy and improve outcomes. In this review, we evaluate the various criteria for locally advanced GBC and the role of imaging in this scenario. Keywords Gallbladder · Carcinoma · Imaging · Neoadjuvant chemotherapy · Locally advanced · Staging
Introduction
* Pankaj Gupta [email protected] 1
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
2
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
3
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
4
Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
5
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
6
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Gallbladder carcinoma (GBC) is the most common malignancy of the biliary system [1]. Though it is uncommon in western countries, it is quite common in India especially in northern states. Surgical resection is the mainstay treatment of early GBC. However, as most of the patients present at advanced stage, curative surgery is not feasible [2]. Less than 10% of patients with GBC present with disease limited to the gallbladder [3]. As surgical resection is curative for GBC, downstaging by neoadjuvant chemotherapy (NACT) may increase the chances of complete re
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