Helical CT of the Local Spread of Carcinoma of the Gallbladder: Evaluation According to the TNM System in Patients Who Underwent Surgical Resection
Kengo Yoshimitsu1,
Hiroshi Honda1,
Kenji Shinozaki1,
Hitoshi Aibe1,
Toshiro Kuroiwa1,
Hiroyuki Irie1,
Kazuo Chijiiwa2,
Yoshiki Asayama3 and
Kouji Masuda1
1 Department of Clinical Radiology, Kyushu University Graduate School of Medical
Sciences, 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582, Japan.
2 Department of Surgery and Oncology, Kyushu University Graduate School of
Medical Sciences, Higashi-ku Fukuoka 812-8582, Japan.
3 Department of Anatomic Pathology, Kyushu University Graduate School of Medical
Sciences, Higashi-ku Fukuoka 812-8582, Japan.
View larger version (158K):
[in a new window]
|
Fig. 1A. —44-year-old man with surgically confirmed T1 lesion of
gallbladder. Axial CT scan obtained through maximal diameter of lesion shows
intraluminal mass (arrow). No definite attachment site is seen, and
lesion was diagnosed as T1 by both observers.
|
|
View larger version (114K):
[in a new window]
|
Fig. 1B. —44-year-old man with surgically confirmed T1 lesion of
gallbladder. Sagittal multiplanar reconstruction of CT scan shows overall
shape of lesion (black arrow) and its broadbased attachment
(white arrow) to gallbladder wall. However, it is not possible to see
whether lesion is confined to mucomuscular layer (T1) or has invaded beyond
that layer (T2). One observer rated this lesion as 4 for T1 category and other
observer rated it as 4 for T2. Lesion was then diagnosed as T2 by
consensus.
|
|
View larger version (187K):
[in a new window]
|
Fig. 1C. —44-year-old man with surgically confirmed T1 lesion of
gallbladder. Photomicrograph of histopathologic specimen reveals tumor to be
confined to mucomuscular layer. No tumor infiltration into subserosal layer is
seen. Note attachment site (arrow). (H and E, x40)
|
|
View larger version (169K):
[in a new window]
|
Fig. 1A. —68-year-old man with surgically confirmed T2 lesion of
gallbladder. Axial CT scan obtained through maximal diameter of carcinoma
shows nodularity (arrow) along serosal aspect of lesion, which was
interpreted as extraserosal infiltration of tumor (T3 lesion) by both
observers.
|
|
View larger version (172K):
[in a new window]
|
Fig. 2B. —68-year-old man with surgically confirmed T2 lesion of
gallbladder. Photomicrograph of histopathologic specimen reveals tumor to be
confined to subserosal layer of gallbladder. Vascular structures
(arrows) with surrounding fibroconnective tissue are seen on serosal
aspect, corresponding to nodularity as seen on A.
|
|
View larger version (179K):
[in a new window]
|
Fig. 3A. —67-year-old woman with surgically confirmed T3 lesion of
gallbladder. Axial CT scan obtained through body to fundus of gallbladder
shows irregular mass with apparent liver (black arrow) and duodenal
(white arrow) wall invasion that was misinterpreted as carcinoma.
Resected specimen revealed lesion to be xanthogranulomatous cholecystitis with
no malignant cells.
|
|
View larger version (179K):
[in a new window]
|
Fig. 3B. —67-year-old woman with surgically confirmed T3 lesion of
gallbladder. Axial CT scan obtained 15 mm cephalad to A shows wall
thickening (arrow) of neck of gallbladder, which has close contact
with adjacent common bile duct (D). Specimen showed lesion to be carcinoma
with serosal and bile duct invasion (T3). Although lesion was initially
overlooked, correct diagnosis of T3 was made by both observers after study
coordinator suggested location of lesion.
|
|
View larger version (169K):
[in a new window]
|
Fig. 4A. —84-year-old woman with surgically confirmed T4 lesion. Axial
CT scan obtained through body of gallbladder shows loss of fat plane
separating tumor (arrow) from liver, suggesting tumor infiltration
into liver. High density in lumen of gallbladder represents milk of calcium
and stones.
|
|
View larger version (174K):
[in a new window]
|
Fig. 4B. —84-year-old woman with surgically confirmed T4 lesion. Axial
CT scan obtained 9 mm caudad to A shows tumor infiltration
(arrow) into duodenum (D). Both observers rated lesion as 5 for T4 on
hard-copy interpretation.
|
|
View larger version (101K):
[in a new window]
|
Fig. 4C. —84-year-old woman with surgically confirmed T4 lesion.
Coronal multiplanar reconstruction of CT scan also shows tumor infiltration
into liver (solid arrow) and duodenum (open arrow). However,
confidence level of diagnosis is no higher than that on axial images (A
and B). Both observers rated lesion as 5 for T4. D = duodenum.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2002 by the American Roentgen Ray Society.
) and soft-copy (
) interpretations of observer 1 when
making T2 determination. Values for area under ROC curve of hard-copy and
soft-copy interpretations were 0.71 and 0.67, respectively, showing no
statistically significant difference (p = 0.45).