Gallbladder auxiliary examination 1. Tumor markers have not yet found specific tumor marker for gallbladder cancer compared with the major CEA and CA19-9 has other, the positive rate of up to 80% – 90%, VII to study found that CA125, CA15- 3, CA242 and other tumor carbohydrate antigen in gallbladder I, n positive rate of those have diagnostic value.
Serum CA19-9IIMi gallbladder gallbladder progress, the positive rate increased gradually. Bile CEA and CA19-9 was significantly higher than the serum, it is suggested that bile tumor markers may be more basis.
Gallbladder auxiliary examination 2. Ultrasonography B-simple non-invasive and can be used repeatedly, the diagnostic accuracy rate HI.6% – 88.8%, should be preferred. Basic features of gallbladder ultrasonography of gallbladder wall thickening, gallbladder cavity is not a fixed location and morphology of the echo mass with acoustic shadowing, mainly for the uplift of early gallbladder cancer lesions with limited wall hypertrophy. There will also be divided into 5 types of gallbladder carcinoma is a small nodules, dirty umbrella, thick-walled type, solid block-type machine mixed. In recent years, high frequency ultrasound probe through the skin or stomach and duodenum (endoscopic ultrasound) pathway in gallbladder scan, greatly improved the detection of gallbladder cancer, and can further determine the structure of the gallbladder wall layers the degree of infiltration by the tumor. Color Doppler flow imaging also helps in diagnosis and differential diagnosis of gallbladder cancer. And wall mass in the bile Ju speed measured blood flow to the abnormal signal is different from primary malignant tumors of gallbladder metastasis of gallbladder or cystic benign tumor of the important features.
Gallbladder auxiliary examination 3. CT scan CT scan of the gallbladder sensitivity to only about 50% – 80%, especially for the early diagnosis of gallbladder cancer as surface ultrasonography or endoscopic ultrasound. But CT can clearly show whining anatomical relationship between the gallbladder and the local thickness of the gallbladder wall, enhanced CT showed gallbladder wall was 90%.
Changes in CT images can be divided into three types:
thick-walled type: limitations of the gallbladder or diffuse irregular thickening of the post.
nodules: papillary nodules broke into the cavity from the gallbladder wall, gallbladder cavity exists.
consolidation type: due to extensive tumor infiltration of the gallbladder wall thickening was combined with the formation of cavities filled with solid mass of people Aikuai. CT shows nodules in the gallbladder, the local lymph node metastasis and adjacent organ invasion Chen has a higher value. In recent years the development of dynamic contrast-enhanced stick away from the sun capsule pain diagnosis, the detection rate of 91%.
4. MR (MRD compared with CT, MRI can provide more information of soft tissue, so the gallbladder and the transfer may be more valuable for other malignant and benign gallbladder disease and more effective. Magnetic resonance imaging of membrane bile duct surgery ( MRCP) is noninvasive and can be displayed with extrahepatic bile duct, and some patients may show gallbladder conditions, has information and CT diagnostic rate similar to the report.
5. Endoscopic retrograde cholangiopancreatography films (ERCP) ERCP investigation about 50% of the gallbladder can not be displayed, to show the gallbladder for gallbladder carcinoma, ERCP diagnosis rate of 70% -90%. ERCP images show gallbladder wall gallbladder filling defect, neat or nipple-like infiltration of the gallbladder wall uplift P wall stiffness or deformation are visible; common bile duct shows irregular narrowing profit by obstruction above the bile duct dilatation with obstruction or bile can understand the pressure, shift and deformation and so on. ERCP under detect tumor markers drawn line bile cytology.
6. Percutaneous transhepatic gallbladder imaging (PTCC) or percutaneous transhepatic capsule examination a (PTCCS) with ultrasound, CT and other noninvasive means rich, pTCC clinical application has been gradually reduced. Imaging showed gallbladder gallbladder PTCC irregular filling defect at the bottom; gallbladder does not develop; or common bile duct stenosis or displacements. PTCCS carved directly into the gallbladder to teach concept of micro-membrane changes, and to remove the lesion under direct vision organized by the Department for pathological examination, is by far the gallbladder (especially early gallbladder) the highest rate of detection methods. PTCCS visible under nodular gallbladder wall, or papillary ridges or small granular surface and irregular nodular Lian bad. Some people will be divided into Type I (protruded) and E (flat); I type is further divided into sessile type (Is) and pedunculated type (Ip), II is divided into flat protruded type (IIa) and Flat (IIb).
7. PTCCS cytology guided by ultrasound or other methods, or laparoscopic gallbladder disease by direct biopsy, or ERCP, B ultrasound-guided gallbladder puncture, PTC, biliary picture-taking bile under the microscope and other methods to find cancer cells, are contribute to the diagnosis of gallbladder cancer. Gallbladder wall puncture biopsy taken for cytological examination, diagnostic accuracy was 85%. Cytology and the combination of imaging methods can improve the diagnostic rate of gallbladder carcinoma.