Multifocality in gallbladder cancer: An imaging-based study

Gallbladder cancer (GBC) lesions are usually solitary. The presence of multifocal disease can alter resectability and management. There are no systematic imaging-based studies evaluating multifocality in GBC. Thus, we aimed to evaluate multifocality in GBC based on cross-sectional imaging studies.

This retrospective study screened cross-sectional imaging (contrast-enhanced computed tomography [CT] or magnetic resonance imaging [MRI]) of consecutive patients with histopathological or cytological diagnoses of GBC. The CT/MRI images of patients with multifocal disease (defined as the presence of two or more foci of abnormal wall thickening, intraluminal polypoidal lesions or masses in the gallbladder, cystic duct, or the extrahepatic bile ducts with the intervening area of normal gallbladder/extrahepatic bile ducts) were evaluated by two radiologists independently for various imaging findings.

Of the 324 patients, 17 (5.2%; 13 females; mean age, 54 ±11 years) had multifocal disease with two sites of involvement in all cases. The most common sites of involvement were the gallbladder fundus and neck region (58.8% of cases), followed by the gallbladder fundus and common bile duct (29.4%). Wall thickening type of GBC was the most common morphological subtype (85.3%), followed by mass forming type (14.7%). The majority (70.6%) of cases showed the same morphology at both sites, while 29.4% showed different morphology. Most (70.6%) of the patients with multifocal GBC were unresectable at the time of diagnosis.

Although rare, imaging-based diagnosis of multifocal GBC may allow appropriate management.