Integrated Radiologic and Intraoperative Assessment of Gallbladder Carcinoma: Evaluating the Role of Multidetector CT in T and N Staging

Abstract

Background: Gallbladder carcinoma (GBC) is an aggressive malignancy often diagnosed at an advanced stage, particularly in South Asian populations. Accurate preoperative staging is essential for surgical planning and prognosis. While multidetector computed tomography (MDCT) is commonly employed for this purpose, its diagnostic performance relative to intraoperative findings remains underexplored in resource-limited settings.

Objective: To evaluate the accuracy of MDCT in predicting T (tumor) and N (nodal) staging in gallbladder carcinoma, using intraoperative findings as the reference standard.

Methods: This prospective cross-sectional study included 50 patients with suspected or radiologically confirmed GBC at Kuwait Teaching Hospital, Peshawar, between December 2024 and June 2025. All patients underwent triphasic contrast-enhanced MDCT using a Toshiba Activion 16-slice scanner, followed by exploratory surgery. T and N staging based on MDCT was compared with intraoperative findings. Sensitivity, specificity, predictive values, accuracy, and Cohen’s kappa coefficient were calculated.

Results: The study population had a mean age of 58.4 years; 68% were female. MDCT demonstrated an overall accuracy of 84% for T staging and 82% for N staging. Sensitivity and specificity for T staging were 87.5% and 80.0%, respectively; for N staging, they were 83.7% and 78.6%. Kappa coefficients indicated substantial agreement between radiologic and intraoperative staging (κ = 0.72 for T; κ = 0.68 for N). Discrepancies were most common in early-stage tumors and in cases of reactive lymphadenopathy.

Conclusion: MDCT shows high diagnostic accuracy in the preoperative staging of gallbladder carcinoma, particularly in identifying advanced-stage disease. While early-stage tumors and nodal involvement may be underestimated, MDCT remains a reliable tool for surgical decision-making in settings lacking immediate histopathology. Integration with intraoperative assessment enhances the effectiveness of staging and improves patient management.