CARCINOMA OF THE GALLBLADDER - CT EVALUATION OF LYMPHATIC SPREAD

PURPOSE: To clarify the,computed tomographic (CT) characteristics of positive nodes and to assess the ability of CT to demonstrate lymphatic spread. MATERIALS AND METHODS: CT findings of lymph nodes in 51 patients with histologically proved gallbladder carcinoma were correlated with pathologic findings retrospectively. RESULTS: Thirty-one of 51 patients (61%) had a total of 157 positive nodes, 60 (38%) of which were depicted at CT. A positive node was defined at CT as a soft-tissue mass with an anteroposterior dimension of at least 10 mm that showed ringlike or heterogeneous enhancement. These criteria had a positive predictive value of 75% for cystic nodes, 90% for pericholedochal nodes, 100% for posterosuperior pancreatoduodenal nodes, 100% for retroportal nodes, 88% for right celiac nodes, 100% for hepatic nodes, 100% for superior mesenteric nodes, and 83% for interaortocaval nodes. CONCLUSION: CT does not reliably demonstrate all regional nodes of gallbladder carcinoma, but the criteria of size and pattern of enhancement reliably indicate lymphatic spread, which has an important bearing on disease staging and treatment planning.