Two‐dimensional Shear Wave Elastography: Utility in Differentiating Gallbladder Cancer From Chronic Cholecystitis

Objective To study the utility of 2D shear wave elastography (SWE) and ascertain cut‐off values of shear wave elasticity (SWe) to differentiate benign and malignant thickening of the gallbladder wall. Methods This study was a prospective study of patients with symptomatic gallstone disease (GSD, n = 51) and gallbladder cancer (GBC, n = 46) and controls without any biliary disease (n = 46). All the participants underwent 2D USG and SWE of the gallbladder. Grey‐scale ultrasound and SWE were done in the different regions in the gallbladder. Results The median age of the patients with GSD was 49 years (interquartile range [IQR]: 33–55), GBC was 55 years (IQR: 46–65), and controls was 37 years (IQR: 27–48.25). In patients with GBC, asymmetrical mural thickening was the predominant imaging pattern (n = 24, 52.2%). The mean SWe of the abnormal area in GBC (34.99 ± 17.77 kPa [n = 46]) was significantly higher than that of the uninvolved region (18.27 ± 8.12 kPa [n = 35]; P < .01). The mean SWe of the uninvolved region in GBC (18.27 ± 8.12 kPa [n = 35]) was also significantly higher ( P < .01) than that of GSD (12.27 ± 4.13 kPa [n = 51]) and controls (10.52 ± 3.75 kPa [n = 46]). On ROC analysis, AUC of 0.927, at a cut‐off of 20 kPa, sensitivity was 91.3%, specificity was 83.5%, positive likelihood ratio was 5.54, and negative likelihood ratio was 0.10 to diagnose GBC. Conclusion The 2D SWE is a reliable adjunctive tool to grey‐scale USG in differentiating the malignant from benign gallbladder wall and may help to pick up early malignancy in GSD.