CT imaging and clinicopathologic differentiation of intracholecystic papillary neoplasm with associated invasive carcinoma and conventional gallbladder adenocarcinoma

초록

Purpose To investigate the different imaging and clinicopathologic features between intracholecystic papillary neoplasm with associated invasive carcinoma (ICPN-IC) and conventional GB adenocarcinoma (c-GBA). Methods We retrospectively reviewed medical records for clinicopathological variables and CT scans of patients who underwent surgery and pathologically confirmed ICPN-IC or c-GBA between 2006 and 2022. Two radiologists independently evaluated CT features, including wall thickness, enhancement pattern, irregularity of inner wall, pericholecystic infiltration, gallstones, lymphadenopathy, and polyps. For polyps, multiplicity, size, shape, base wall thickening, and dimpling were analyzed. Logistic regression was employed to identify significant CT predictors. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic model's efficacy for differentiating ICPN-IC from c-GBA. Results Sixty-nine patients with ICPN-IC and 312 patients with c-GBA were included (mean age, 67.6 years +/- 10.4). ICPN-IC were more likely to present with T1 stage than c-GBA (39/69 [56.5%] vs. 72/312 [23.1%]; p < 0.001). In multivariable analysis, irregularity of inner wall (odds ratio [OR], 3.11, p < 0.001), lymphadenopathy (OR, 0.23, p = 0.02) and presence of polypoid lesion (OR, 5.64, p < 0.001) were independent predictors of ICPN-IC. Multiple polyps were observed more frequently in ICPN-IC than in c-GBA (33/59 [55.9%] vs. 45/170 [26.5%]; p < 0.001). The diagnostic model performance for differentiating ICPN-IC from c-GBA was 0.73 with a sensitivity of 82.6% and a specificity of 53.2%. Conclusion CT may be helpful in differentiating ICPN-IC from c-GBA using image features including irregularity of inner wall, lymphadenopathy, and presence of polyp with multiplicity.

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