INVESTIGATING GALLBLADDER FOCAL WALL THICKNESS AS AN EARLY INDICATOR FOR MALIGNANCY: EXPLORING ITS SIGNIFICANCE IN EARLY DETECTION THROUGH HISTOPATHOLOGICALANALYSIS
Authors: Ahmad Md Sohail , Paul Saurav Kumar , Kumar Sushant , Kumari Jyoti 
Published: November 2024

Background: Gallbladder cancer often goes undetected until surgery for non-cancerous gallbladderConditions. Different patterns of thickening
are observed, with gallbladder cancer manifesting in diffuse, segmental, or focal forms, frequently resulting in thickened walls. Imaging aids in
evaluation, but distinguishing cancerous thickening from benign causes remains challenging. Histopathological analysis is crucial for accurate
diagnosis, allowing for early detection and informed clinical decisions. Methods: This prospective observational study was conducted at
Darbhanga Medical College and Hospital from August 2023 to March 2024, analyzing 60 cases. Inclusion criteria involved patients aged 18-50
with gallbladder focal wall thickness exceeding 3.5mm on ultrasonography. Exclusion criteria included contraindications to imaging procedures,
prior gallbladder surgery after age 50, unwillingness for surgery, and suspicion of metastatic disease. Eligible patients received counseling,
provided consent, and underwent documentation of demographics and clinical parameters. Cholecystectomy was performed for qualifying
patients, with post-surgery specimens examined histopathologically. Data integration and statistical analysis adhered to ethical standards, with a pvalue of ≤ 0.05 considered signicant, and ongoing collaboration among the research team was maintained. Results: In our study of 60 cases,
patient demographics revealed a majority in the age range of 51-60 years, with females comprising 34 cases and males 26. USG proved effective as
a screening tool for gallbladder pathology, highlighting cholesterosis as the most common condition and gallbladder tumefactive sludge as the least
frequent. CECT emerged as superior in conrming suspicious malignant pathology. A signicant association (p-value < 0.0001) between
gallbladder wall thickness observed on USG and HPE indicated a higher risk of malignancy with increased thickness. A similar association was
noted with CECT ndings (p-value< 0.0001), with thicker gallbladder walls suggesting a greater risk of malignancy. Discussion: In a prospective
observational study at Darbhanga Medical College, 60 cases with gallbladder focal wall thickness over 3mm on USG were examined, correlating
with HPE reports. Various conditions were identied, including chronic cholecystitis (16.6%), parasitic granuloma (3.33%), adenocarcinoma
(11.6%), xanthogranulomatous cholecystitis (25%), gallbladder polyps (11.6%), and cholesterosis (31.6%). Reference studies highlighted
alternative surgical approaches for gallbladder cancer, with signicant ndings in xanthogranulomatous cholecystitis cases. The study emphasizes
the importance of early detection in improving prognosis. Moreover, gallbladder polyps and wall thickening patterns were explored, with imaging
modalities aiding in diagnosis. Notably, the Gallbladder Reporting and Data System (GB-RADS) facilitates consistent assessment of malignancy
risk. Statistical analysis revealed a signicant association between gallbladder wall thickening and malignant potential. Overall, the study
underscores the complexity of distinguishing benign and malignant gallbladder conditions, advocating for comprehensive diagnostic approaches.
Conclusion: Gallbladder cancer, though rare, is highly lethal, often asymptomatic initially but discovered incidentally. Abnormalities indicating
gallbladder cancer require comprehensive assessment and potential surgical intervention. Our study establishes a signicant correlation between
radiological patterns and histopathological ndings, facilitating early detection and potentially improving survival rates.