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A deep learning model based on contrast-enhanced computed tomography for differential diagnosis of gallbladder carcinoma

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 376-384页

作者： Fei Xiang Qing-Tao Meng Jing-Jing Deng Jie Wang Xiao-Yuan Liang Xing-Yu Liu Sheng Yan Department of Hepatobiliary Pancreatic Surgery Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Radiology Affiliated Chuzhou First People’s HospitalAnhui Medical UniversityChuzhou 239000China

Background:gallbladder carcinoma(GBC)is highly malignant,and its early diagnosis remains *** study aimed to develop a deep learning model based on contrast-enhanced computed tomography(CT)images to assist radiologists in identifying ***:We retrospectively enrolled 278 patients with gallbladder lesions(>10 mm)who underwent contrast-enhanced CT and cholecystectomy and divided them into the training(n=194)and validation(n=84)*** deep learning model was developed based on ResNet50 *** and clinical models were built based on support vector machine(SVM)*** comprehensively compared the performance of deep learning,radiomics,clinical models,and three ***:Three radiomics features including LoG_3.0 gray-level size zone matrix zone variance,HHL firstorder kurtosis,and LHL gray-level co-occurrence matrix dependence variance were significantly different between benign gallbladder lesions and GBC,and were selected for developing radiomics *** regression analysis revealed that age≥65 years[odds ratios(OR)=4.4,95%confidence interval(CI):2.1-9.1,P37 U/mL(OR=4.0,95%CI:1.6-10.0,P=0.003)were significant clinical risk factors of *** deep learning model achieved the area under the receiver operating characteristic curve(AUC)values of 0.864(95%CI:0.814-0.915)and 0.857(95%CI:0.773-0.942)in the training and validation datasets,which were comparable with radiomics,clinical models and three *** sensitivity of deep learning model was the highest both in the training[90%(95%CI:82%-96%)]and validation[85%(95%CI:68%-95%)]***:The deep learning model may be a useful tool for radiologists to distinguish between GBC and benign gallbladder lesions.

关键词： gallbladder carcinoma Computed tomography Deep learning Radiomics

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New trends in diagnosis and management of gallbladder carcinoma

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 13-29页

作者： Efstathios T Pavlidis Ioannis N Galanis Theodoros E Pavlidis ^(nd)Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

gallbladder(GB)carcinoma,although relatively rare,is the most common biliary tree cholangiocarcinoma with aggressiveness and poor *** is closely associated with cholelithiasis and long-standing large(>3 cm)gallstones in up to 90%of *** other main predisposing factors for GB carcinoma include molecular factors such as mutated genes,GB wall calcification(porcelain)or mainly mucosal microcalcifications,and GB polyps≥1 cm in *** is made by ultrasound,computed tomography(CT),and,more precisely,magnetic resonance imaging(MRI).Preoperative staging is of great importance in decisionmaking regarding therapeutic *** staging is based on MRI findings,the leading technique for liver metastasis imaging,enhanced three-phase CT angiography,or magnetic resonance angiography for major vessel *** is also necessary to use positron emission tomography(PET)-CT or ^(18)F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic *** laparoscopy may detect dissemination not otherwise found in 20%-28.6%of *** treatment is needed,including surgical resection,targeted therapy by biological agents according to molecular testing gene mapping,chemotherapy,radiation therapy,and *** is of great importance to understand the updated guidelines and current treatment *** extent of surgical intervention depends on the disease stage,ranging from simple cholecystectomy(T1a)to extended resections and including extended cholecystectomy(T1b),with wide lymph node resection in every case or IV-V segmentectomy(T2),hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y,and adjacent organ resection if necessary(T3).Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery,but much attention must be paid to avoiding *** addition to surgery,novel targe

关键词： Biliary tract neoplasms Extrahepatic cholangiocarcinoma gallbladder carcinoma gallbladder diseases Biliary tree diseases Gastrointestinal malignancies

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gallbladder carcinoma associated with pancreatobiliary reflux

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World Journal of Gastroenterology 2006年第40期12卷 6527-6530页

作者： Jin Kan Sai Masafumi Suyama Yoshihiro Kubokawa Bunsei Nobukawa Department of Gastroenterology Juntendo University 2-1-1 Hongo Bunkyo-ku Tokyo 113-8421 Japan Department of Pathology Juntendo University 2-1 - 1 Hongo Bunkyo-ku Tokyo 113-8421 Japan

AIM: To detect the patients with and without pan-creaticobiliary maljunction who had pancreatobiliary reflux with extremely high biliary amylase ***: Ninety-six patients, who had diffuse thickness (> 3 mm) of the gallbladder wall and were suspected of having a pancreaticobiliary maljunction on ultrasonography, were prospectively subjected to endoscopic retrograde cholangiopancreatography, and bile in the common bile duct was sampled. Among them, patients, who had extremely high biliary amylase levels (>10 000 IU/L), underwent cholecystectomy, and the clinicopathological findings of those patients with and without pancreaticobiliary maljunction were ***: Seventeen patients had biliary amylase levels in the common bile duct above 10 000 IU/L, including 11 with pancreaticobiliary maljunction and 6 without pancreaticobiliary maljunction. The occurrence of gallbladder carcinoma was 45.5% (5/11) in patients with pancreaticobiliary maljunction, and 50% (3/6) in those without pancreaticobiliary ***: Pancreatobiliary reflux with extremely high biliary amylase levels and associated gallbladder carcinoma could be identified in patients with and without pancreaticobiliary maljunction, and those patients might be detected by ultrasonography and bile sampling.

关键词： Amylase Bile gallbladder carcinoma Pancreatobiliary reflux Pancreaticobiliary maljunction Diagnosis

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Efficacy and safety of gemcitabine-oxaliplatin combined with huachansu in patients with advanced gallbladder carcinoma

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World Journal of Gastroenterology 2008年第33期14卷 5210-5216页

作者： Tian-Jie Qin Xin-Han Zhao Jun Yun Ling-Xiao Zhang Zhi-Ping Ruan Bo-Rong Pan Department of Medical Oncology First Affiliated Hospital of Medical School of Xi'an Jiaotong University Xi'an 710061 Shaanxi Province China Outpatient Department of Oncology Cancer Institute Fourth Military Medical University Xi'an 710032 Shaanxi Province China Department of the Third General Surgery Xijing Hospital Fourth Military Medical University Xi'an 710032 Shaanxi Province China

AIM: To evaluate the efficacy and safety of gemcitabine-oxaliplatin (GEMOX) combined with huachansu (cinobufagin) injection treatment in patients with locally advanced or metastatic gallbladder carcinoma (GBC), and to assess the quality of life (QOL) of such patients. METHODS: Twenty-fi ve patients with locally advanced or metastatic GBC were treated with intravenous gemcitabine (1000 mg/m2) over 30 min on days 1 and 8, 2 h infusion of oxaliplatin (120 mg/m2) on day 1, and 2-3 h infusion of huachansu (20 mL/m2) on days -3-11, every 3-4 wk. Treatment was continued until occurrence of unacceptable toxicity or disease progression. QOL of patients was assessed by the EORTC QLQ-C30 at baseline, at the end of the fi rst, third and sixth chemotherapy cycles, and 1 mo after the treatment. RESULTS: Among the 25 patients with a median age of 64 years (range 42-78 years), 23 were evaluable in the study. A total of 137 cycles of therapy were performed and the median cycle was 5 (range 1-8) per patient. Out of the 23 patients whose response couldbe evaluated, 8 partial responses (PR) were observed (34.8%), while 7 patients (30.4%) demonstrated a stable disease (SD). The disease control rate was 65.2%. Progression of cancer was observed in 8 (34.8%) patients. The median progression-free and overall survival time was 5.8 mo (95% CI: 4.5-7.1 mo) and 10.5 mo, respectively. The therapy was well tolerated, with moderate myelosuppression as the main toxicity. Anemia grade 2 was seen in 16.0%, neutropenia grade 3 in 8.0% and thrombocytopenia grade 3 in 24.0% of patients, respectively. Non-hematologic toxicity ranged from mild to moderate. No death occurred due to toxicity. The QOL of patients was improved after chemotherapy, and the scores of QOL were increased by 10 to 20 points. CONCLUSION: GEMOX combined with huachansu (cinobufagin) injection is well tolerated, effective, thus improving the QOL of patients with advanced GBC.

关键词： gallbladder carcinoma Gemcitabine Oxaliplatin Huachansu injection Quality of life

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Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

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World Journal of Gastroenterology 2010年第28期16卷 3567-3572页

作者： Naohiko Kohya Kenji Kitahara Kohji Miyazaki Departmen of Surgery Saga University Faculty of Medicine5-1-1 Nabeshi maSaga 849-8501Japan

AIM:To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma(GBCa)according to tumor spread in the subserosal layer. METHODS:A series of 84 patients with GBCa were treated at Saga University Hospital,Japan between April 1989 and October *** tumor stage was graded according to the TNM staging for GBCa from the American Joint Committee on Cancer Manual 6th edition. Tumor staging revealed 30 patients with T2 tumors.T2 GBCa was divided into three groups histologically by the extent of tumor spread in the subserosal layer,using a score of ss minimum(ss min),ss medium(ss med)or ss massive(ss mas). RESULTS:For ss min GBCa,there was no positive pathological factor and patient survival was satisfactory with simple cholecystectomy,with or without extra-he- patic bile duct *** ss med GBCa,some pathological factors,h-inf(hepatic infiltration),ly(lymphatic invasion)and n(lymph node metastasis),were positive. For ss mas GBCa,there was a high incidence of positive pathological *** patient group with extra-hepatic bile duct resection with D2 lymph node dissection (BDR with D2)and those with S4a5 hepatectomy had significantly better survival ***:We suggest that radical surgery is not necessary for ss min GBCa,and partial hepatectomy and BDR are necessary for both ss med and ss mas GBCa.

关键词： Hepatectomy Bile duct resection gallbladder carcinoma Tumor spread

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CD133^+ gallbladder carcinoma cells exhibit self-renewal ability and tumorigenicity

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World Journal of Gastroenterology 2011年第24期17卷 2965-2971页

作者： Cheng-Jian Shi Jun Gao Min Wang Xin Wang Rui Tian Feng Zhu Ming Shen Ren-Yi Qin Department of Biliary-pancreatic Surgery Affiliated Tongji Hospital Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430030 Hubei Province China Department of General Surgery The Affiliated Hospital of Qingdao University Medical College Qingdao 266003 Shandong Province China

AIM： To identify cancer stern cells （CSCs） in human gallbladder carcinomas （GBCs）. METHODS： Primary GBC cells were cultured under serum-free conditions to produce floating spheres. The stem-cell properties of the sphere-forming cells, including self-renewal, differentiation potential, chemoresistance and tumorigenicity, were determined in vitro or in vivo. Cell surface expression of CD133 was investigated in primary tumors and in spheroid cells using flow cytometry. The sphere-colony-formation ability and tumorigenicity of CD133＋ cells were *** spheroids were generated from primary GBC cells, and these sphere-forming cells could generate new progeny spheroids in serum-free media. Spheroid cells were differentiated under serum-containing conditions with downregulation of the stem cell markers Oct-4, Nanog, and nestin （P 〈 0.05）. The differentiated cells showed lower spheroid-colony-formation ability than the original spheroid cells （P 〈 0.05）. Spheroid ceils were more resistant to chemotherapeutic reagents than the congenetic adherent cells （P 〈 0.05）. Flow cytometry showed enriched CD133＋ population in sphereforming cells （P 〈 0.05）. CD133＋ cells possessed high colony-formation ability than the CD133 population （P 〈 0.01）. CD133＋ cells injected into nude mice revealed higher tumorigenicity than their antigen-negative counterparts （P 〈 0.05）. CONCLUSION： CD133 may be a cell surface marker for CSCs in GBC.

关键词： gallbladder carcinoma Cancer stem cell Non-adherent spheres CD133 protein Self-renewal Tumorigenicity

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Clinicopathological significance of altered Notch signaling in extrahepatic cholangiocarcinoma and gallbladder carcinoma

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World Journal of Gastroenterology 2011年第35期17卷 4023-4030页

作者： Hyun Ah Yoon Myung Hwan Noh Byung Geun Kim Ji Sun Han Jin Seok Jang Seok Ryeol Choi Jin Sook Jeong Jin Ho Chun Department of Gastroenterology Dong-A University Hospital3-1Dong dae shindongSeo-guBusan 602-715South Korea Department of Pathology Dong-A University Hospital3-1Dong dae shin-dongSeo-guBusan 602-715 South Korea Department of Preventive Medicine Inje University HospitalGae gum 2-dongBusanjinguBusan 614-735 South Korea

AIM:To investigate the role and clinicopathological significance of aberrant expression of Notch receptors and Delta-like ligand-4 (DLL4) in extrahepatic cholangiocarcinoma and gallbladder ***:One hundred and ten patients had surgically resected extrahepatic cholangiocarcinoma (CC) and gallbladder carcinoma specimens examined by immunohistochemistry of available paraffin *** was performed using anti-Notch receptors 1-4 and anti-DLL4 *** scored the immunopositivity of Notch receptors and DLL4 expression by percentage of positive tumor cells with cytoplasmic expression and intensity of *** nuclear localization was ***-logical parameters and survival data were compared with the expression of Notch receptors 1-4 and ***:Notch receptor proteins showed in the cytoplasm with or without nuclear expression in cancer cells,as well as showing weak cytoplasmic expression in non-neoplastic *** semiquantitative evaluation,positive immunostaining of Notch receptor 1 was detected in 96 cases (87.3%),Notch receptor 2 in 97 (88.2%),Notch receptor 3 in 97 (88.2%),Notch receptor 4 in 103 (93.6),and DLL4 in 84 (76.4%).In addition,coex- istent nuclear localization was noted [Notch receptor 1;18 cases (18.8%),Notch receptor 2;40 (41.2%),Notch receptor 3;32 (33.0%),Notch receptor 4;99 (96.1%),DLL4;48 (57.1%)].Notch receptor 1 expression was correlated with advanced tumor,node,metastasis (TNM) stage (P=0.043),Notch receptor 3 with advanced T stage (P=0.017),tendency to express in cases with nodal metastasis (P=0.065) and advanced TNM stage (P=0.052).DLL4 expression tended to be related to less histological differentiation (P=0.095).Coexistent nuclear localization of Notch receptor 3 was related to no nodal metastasis (P=0.027) and Notch receptor 4 with less histological differentiation (P=0.036),while DLL4 tended to be related inversely with T stage (P=0.053).Coexistent nuclear localizatio

关键词： Notch receptors Delta-like ligand-4 Cholangio-carcinoma gallbladder carcinoma Immunohistochemistry

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Clinical strategies for differentiating IgG4-related cholecystitis from gallbladder carcinoma to avoid unnecessary surgical resection

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Science China(Life Sciences) 2020年第5期63卷 764-770页

作者： Rui Zhang Hao-Ming Lin Zhao-Xi Cai Su-Juan Du Hong Zeng Lei-Bo Xu Jie Wang Chao Liu Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreas Surgery Sun Yat-sen Memorial HospitalSunYat-sen UniversityGuangzhou 510120China Department of Radiology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Department of Anesthesia Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Department of Pathology Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China

Immunoglobulin G4(IgG4)-related cholecystitis(IgG4-C)is often difficult to distinguish from gallbladder carcinoma(GBC).This study aimed to determine a practical strategy for differentiating between IgG4-C and GBC to avoid unnecessary surgical *** expression of IgG4 in the gallbladder was detected by *** clinicopathological and radiological characteristics of IgG4-C patients and GBC patients were analyzed *** revealed that IgG4 was upregulated in the plasma cells of IgG4-C *** median serum total bilirubin levels were significantly higher in the patients with IgG4-C than in those with GBC(45.8μmol L^-1 vs.29.9μmol L^-1).The serumγ-GGT levels were higher in IgG4-C patients than in GBC patients,whereas the serum levels of CA125 were significantly higher in GBC patients than in IgG4-C *** imaging scans were helpful for differentiating IgG4-C from GBC based on the presence of a layered pattern and Rokitansky-Aschoff sinuses in the gallbladder *** were no statistically significant differences in age,presence of abdominal pain,level of emaciation between the two *** study demonstrated that the combination of imaging with serum total bilirubin,γ-GGTand CA125 levels can offer added preoperative diagnostic value and reduce the rate of IgG4-C misdiagnosis.

关键词： clinical strategies IgG4-cholecystitis gallbladder carcinoma surgical resection

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Expression of angiostatin cDNA in human gallbladder carcinoma cell line GBC-SD and its effect on endothelial proliferation and growth

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World Journal of Gastroenterology 2006年第17期12卷 2762-2766页

作者： Ding-Zhong Yang Jing He Ji-Cheng Zhang Zuo-Ren Wang Department of Surgery The First Hospital Xi'an Jiaotong University Xi'an 710065 Shannxi Province China Deparment of Pharmacology University of Texas Medical Branch Galveston 77555 Texas State United States Department of surgery Union Hospital Fujian Medical University Fuzhou 350001 Fujian Province China Department of surgery The First Hospital Xi' an Jiaotong University Xi'an 710065 Shannxi Province China

AIM： To explore the influence of angiostatin up-regulation on the biologic behavior of gallbladder carcinoma cells in vitro and in vitro, and the potential value of angiostatin gene therapy for gallbladder carcinoma. METHODS： A eukaryotic expression vector of pcDNA3.1（＋） containing murine angiostatin was constructed and identified by restriction endonuclease digestion and sequencing. The recombinant vector pcDNA3.1-angiostatin was transfected into human gallbladder carcinoma cell line GBC-SD with Upofectamine 2000, and paralleled with the vector and mock control. The resistant clone was screened by G418 filtration. Angiostatin transcription and protein expression were examined by RT-PCR, immunofluorescence and Western-blot. The supernatant was collected to treat endothelial cells. Cell proliferation and growth in vitro were observed under microscope. RESULTS： Murine angiostatin cDNA was successfully cloned into the eukaryotic expression vector pcDNA3.1 （＋）. AFter 14 d of transfection and selection with G418, macroscopic resistant cell cloning was formed in the experimental group transfected with pcDNA 3.1（＋）-angiostatin and vector control. But untreated cells died in the mock control. Angiostatin was detected by RT-PCR and protein expression was detected in the experimental group by immunofluorescence and Western-blot. Cell proliferation and growth in v/tro in the three groups were observed respectively under microscope. No significant difference was observed in the growth speed of GBC- SD cells between groups that were transfected with and without angiostatin. After treatment with supernatant, significant differences were observed in endothelial cell （ECV-304） growth in vitro. The cell proliferation and growth were inhibited. CONCLUSION： Angiostatin does not directly inhibit human gallbladder carcinoma cell proliferation and growth in vitro, but the secretion of angiostatin inhabits endothelial cell proliferation and growth.

关键词： Angiostatin gallbladder carcinoma Endothelial cell

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γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

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World Journal of Gastrointestinal Oncology 2020年第9期12卷 1014-1030页

作者： Le-Jia Sun Ai Guan Wei-Yu Xu Mei-Xi Liu Huan-Huan Yin Bao Jin Gang Xu Fei-Hu Xie Hai-Feng Xu Shun-Da Du Yi-Yao Xu Hai-Tao Zhao Xin Lu Xin-Ting Sang Hua-Yu Yang Yi-Lei Mao Department of Liver Surgery Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China Department of Clinical Medicine Peking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China Department of General Surgery Beijing Friendship HospitalCapital Medical UniversityBeijing 100730China

BACKGROUND gallbladder carcinoma(GBC)carries a poor prognosis and requires a prediction ***-glutamyl transferase–to–platelet ratio(GPR)is a recently reported cancer prognostic *** the mechanism for the relationship between GPR and poor cancer prognosis remains unclear,studies have demonstrated the clinical effect of both gamma-glutamyl transferase and platelet count on GBC and related gallbladder *** To assess the prognostic value of GPR and to design a prognostic nomogram for *** The analysis involved 130 GBC patients who underwent surgery at Peking Union Medical College Hospital from December 2003 to April *** patients were stratified into a high-or low-GPR *** predictive ability of GPR was evaluated by Kaplan–Meier analysis and a Cox regression *** developed a nomogram based on GPR,which we verified using calibration *** nomogram and other prognosis prediction models were compared using timedependent receiver operating characteristic curves and the concordance *** Patients in the high-GPR group had a higher risk of jaundice,were older,and had higher carbohydrate antigen 19-9 levels and worse postoperative *** analysis revealed that GPR,age,body mass index,tumor–node–metastasis(TNM)stage,jaundice,cancer cell differentiation degree,and carcinoembryonic antigen and carbohydrate antigen 19-9 levels were related to overall survival(OS).Multivariate analysis confirmed that GPR,body mass index,age,and TNM stage were independent predictors of poor *** curves were highly consistent with actual *** of timedependent receiver operating characteristic curves and the concordance index showed advantages for the nomogram over TNM *** GPR is an independent predictor of GBC prognosis,and nomogram-integrated GPR is a promising predictive model for OS in GBC.

关键词： Gamma-glutamyl transferase-to-platelet ratio gallbladder carcinoma Prognosis Nomogram Tumor-node-metastasis Patient management

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