The role of PET scans in the management of Cholangiocarcinoma and Gallbladder Cancer: A systematic review for surgeons

Introduction: Radical surgical resection is the only potentially curative therapy for cancers arising in biliary epithelia (gallbladder cancer and cholangiocarcinoma). Accurate radiological staging is crucial and the role of positron emission tomography-CT (PET-CT) scanning in this regard is undefined. Methods: A systematic review of the literature was carried out to define the accuracy of PET-CT in patients with cholangiocarcinoma or gallbladder cancer in defining metastatic disease in portal, and extra-portal lymph nodes, the presence of intra-hepatic satellite lesions, extra-abdominal metastases and recurrent disease in patients following treatment. Results were displayed in a narrative format with no meta-analysis feasible. Results & Conclusions: Four hundred and sixty eight records were screened, 49 were assessed and 12 studies were included in the systematic review. PET-CT has a low sensitivity for regional lymph node metastases from cholangiocarcinoma and gallbladder cancer but a high specificity. In one study, PET-CT appears to be effective in assessing all nodal basins related to the liver, bile ducts and gallbladder. PET-CT has no role in the assessment of hepatic satellite lesions but is useful in defining extra-abdominal metastatic disease and recurrent disease and to assess specific areas of concern defined on CT scan and/or magnetic resonance scan.