Advertisement

Focusing in on gallbladder disease. Do current imaging modalities accurately depict the severity of final pathology?

Published:October 16, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.029

      Highlights

      • Cohen's Kappa statistic is used to describe agreement between modalities.
      • Minimal agreement exists between US and final gallbladder disease (GBD) pathology.
      • Only minimal agreement exists between CT and final GBD pathology.
      • Urgent cholecystectomy should be considered for suspected GBD despite imaging.

      Abstract

      Background

      Accuracy of imaging modalities for gallbladder disease(GBD) remains questionable. We hypothesize ultrasonography(US), computed tomography(CT), and magnetic resonance imaging(MRI) poorly correlate with final pathologic analysis.

      Methods

      This was a retrospective review of all patients who underwent cholecystectomy at our institution. Primary outcome was agreement between US, CT, and MRI, and final pathology report of the gallbladder. Cohen's Kappa statistic was used to describe the level of agreement (0 = agreement equivalent to chance, 0.1–0.2 = slight agreement, 0.21–0.40 = minimal/fair agreement, 0.41–0.60 = moderate agreement, 0.61–0.80 = substantial agreement, 0.81–0.99 = near perfect agreement, 1 = perfect agreement). Significance was set at p < 0.05.

      Results

      1107 patients were enrolled. Average age was 48.6(±17.6); 64.2% were female. There was minimal agreement between the three imaging modalities and final pathology (US = 0.363; CT = 0.223; MRI = 0.351;p < 0.001).

      Conclusion

      Poor agreement exists between imaging modalities and final pathology report for GBD. Urgent surgical intervention for patients presenting with symptoms of GBD should be considered, despite imaging results.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sheffield K.M.
        • Ramos K.E.
        • Djukom C.D.
        • et al.
        Implementation of a critical pathway for complicated gallstone disease: translation of population-based data into clinical practice.
        J Am Coll Surg. 2011; 212: 835-843
        • Banz V.
        • Gsponer T.
        • Candinas D.
        • Güller U.
        Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy.
        Ann Surg. 2011; 254: 964-970
        • Roulin D.
        • Saadi A.
        • Di Mare L.
        • Demartines N.
        • et al.
        Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule?.
        Ann Surg. 2016; 264: 717-722
        • Ozkardeş A.B.
        • Tokaç M.
        • Dumlu E.G.
        • et al.
        Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study.
        Int Surg. 2014; 99: 56-61
        • Gurusamy K.S.
        • Samraj K.
        Early versus delayed laparoscopic cholecystectomy for acute cholecystitis.
        Cochrane Database Syst Rev. 2006; 4 (CD005440)
        • Yokoe
        • Hata J.
        • Takada T.
        • et al.
        Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos).
        J Hepatobiliary Pancreat Sci. 2018; 25: 41-54
        • Kulvatunyou N.
        • Joseph B.
        • Gries L.
        • et al.
        A prospective cohort study of 200 acute care gallbladder surgeries: the same disease but a different approach.
        J Trauma Acute Care Surg. 2012; 73: 1039-1045
        • Bingener J.
        • Schwesinger W.H.
        • Chopra S.
        • Richards M.L.
        • et al.
        Does the correlation of acute cholecystitis on ultrasound and at surgery reflect a mirror image?.
        Am J Surg. 2004; 188: 703-707
        • Wertz J.R.
        • Lopez J.M.
        • Olson D.
        • Thompson W.M.
        Comparing the diagnostic accuracy of ultrasound and CT in evaluating acute cholecystitis.
        AJR Am J Roentgenol. 2018; 211: W92-W97
        • Lawrentschuk N.
        • Hewitt P.M.
        • Pritchard M.G.
        Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery.
        ANZ J Surg. 2003; 73: 890-893
        • Rutledge D.
        • Jones D.
        • Rege R.
        Consequences of delay in surgical treatment of biliary disease.
        Am J Surg. 2000; 180: 466-469
        • Katabathina V.S.
        • Zafar A.M.
        • Suri R.
        Clinical presentation, imaging, and management of acute cholecystitis.
        Tech Vasc Intervent Radiol. 2015; 18: 256-265
        • Kiewiet J.J.
        • Leeuwenburgh M.M.
        • Bipat S.
        • et al.
        A systemic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis.
        Radiology. 2012; 264: 708-720
        • Nadiu K.
        • Beenen E.
        • Gananadha S.
        • Mosse C.
        The yield of fever, inflammatory markers and ultrasound in the diagnosis of acute cholecystitis: a validation of the 2013 Tokyo Guidelines.
        World J Surg. 2016; 40: 2892-2897
        • Ansaloni L.
        • Pisano M.
        • Coccolini F.
        • et al.
        2016 WSES guidelines on acute calculous cholecystitis.
        World J Emerg Surg. 2016; 11: 25
        • Hwang H.
        • Marsh I.
        • Doyle J.
        Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital.
        Can J Surg. 2014; 57: 162-168
        • Kaoutzanis C.
        • Davies E.
        • Leightle S.W.
        • et al.
        Abdominal ultrasound versus hepato-imino diacetic acid scan in diagnosing acute cholecystitis—what is the real benefit?.
        J Surg Res. 2014; 188: 44-52
        • Rodriguez L.E.
        • Santaliz-Ruiz L.E.
        • De La Torre-Bisot G.
        • et al.
        Clinical implications of hepatobiliary scintigraphy and ultrasound in the diagnosis of acute cholecystitis.
        Int J Surg. 2016; 35: 196-200
        • Villar J.
        • Summars S.M.
        • Menchine M.D.
        • et al.
        The absence of gallstones on point-of-care ultrasound rules out acute cholecystitis.
        J Emerg Med. 2015; 49: 475-480
        • European Association of the Study of the Liver (EASL)
        EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones.
        J Hepatol. 2016; 65: 146-181
        • Internal Clinical Guidelines Team (UK)
        Gallstone Disease: Diagnosis and Management of Cholelithiasis, Cholecystitis, and Choledocholithiasis.
        National Institute for Health and Care Excellence (UK), London2014 Oct
        • Barie P.S.
        • Eachempati S.R.
        Acute acalculous cholecystitis.
        Gastroenterol Clin N Am. 2010; 39: 343-357