R. A. Rodriguez1, H. Overton2, K. Morris1, I. Nir1, M. Williamson3, A. Rajput1 1University Of New Mexico,Division Of Surgical Oncology, Department Of Surgery,Albuquerque, NM, USA 2University Of New Mexico,School Of Medicine,Albuquerque, NM, USA 3University Of New Mexico,Department Of Radiology,Albuquerque, NM, USA
Introduction: The highest incidence rates of gallbladder cancer (GBC) in the continental United States are in New Mexico and amongst the minority-majority Native American and Hispanic populations. This cancer is often fatal as most patients present with advanced stages of disease. Early diagnosis remains a challenge as specific signs and symptoms are absent. Early stages of disease, which have a more favorable outcome, are often found incidentally at time of cholecystectomy. The purpose of this study was to determine the incidence of gallbladder pathology in patients undergoing cholecystectomy and to correlate any pre-operative radiographic findings with the pathology.
Methods: Healthsystem database was queried for patients who underwent cholecystectomy between 1991 and 2013. A total of 6793 patients were identified. Data extracted included: demographics, previous ultrasound report, surgical and pathologic reports. Pathologic findings including gallbladder cancer, dysplasia, metaplasia and polyps were recorded. Radiographic reports were reviewed to determine if pre-operative finding predicted final pathologic diagnosis.
Results: There were 4993 (74%) females. Female patients were more likely to present at an older age (52.5) compared to males (45.4); patients who were found to have GBC were more likely to be older (73.4). Out of a total of 17 GBCs identified, 5 (29%) patients were known to have malignancy prior to surgery and 12 (71%) were discovered to have malignancy on pathologic analysis. Pre-operative radiographic findings correlated to pathological findings in only 3 (18%) cases. GB pathology stratified by ethnic group is shown in table 1. GB pathology was more likely to be found in Hispanics and Native Americans although the incidence of pathology was not statistically significant amongst ethnicities in our data set.
Conclusion: Although rare, gallbladder pathology is incidentally found at the time of cholecystectomy. The diagnosis of cancer, dysplasia, metaplasia and polyps was more common in Hispanics and Native Americans as compared to non-Hispanic whites. Although ultrasonography continues to be a good diagnostic method for gallstones and cholecystitis, its utility in other gallbadder pathologies remains unproven. There is a need to develop new screening and diagnostic methods for patients with gallbladder cancer.
