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Ultrasound-guided fine needle aspiration cytology of malignant gallbladder masses
V K Shukla1, M Pandey, M Kumar
1Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Objective:
To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses.
Study Design:
We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases.
Results:
After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease.
Conclusion:
US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.