Endoscopic ultrasound for nodal staging in patients with resectable gallbladder cancer

BACKGROUND AND OBJECTIVES: Accurate pre-operative lymph node (LN) staging is essential for guiding treatment decisions in gallbladder cancer (GBC). This study evaluated the impact of endoscopic ultrasound (EUS) with tissue acquisition (EUS-TA) on LN staging in presumed resectable GBC. METHODS: This retrospective, single-center study, included patients with potentially resectable GBC who underwent pre-operative EUS between January 2019 and November 2024. The primary outcome was the impact of EUS on clinical decision making, defined as preclusion from surgical exploration by identification of LN metastasis. Secondary outcomes were missed LN metastases and complications. RESULTS: Fifty-six patients were included, undergoing 59 EUS procedures. Lymphadenopathy was reported on pre-operative cross-sectional imaging in 54.7% of patients. During EUS, 46 LN were identified and EUS-TA was performed on 24 LN in 21 patients. LN metastases were confirmed by EUS-TA in 10.7% of patients, leading to preclusion from surgical treatment. Among patients who underwent surgical exploration, regional LN metastases were identified in nine of 31 patients and extra-regional LN metastases in one patient. There were no complications. CONCLUSIONS: Pre-operative EUS influenced management in patients with presumed resectable GBC by detecting LN metastases altering the treatment approach. However, its non-systematic approach resulted in missed regional LN involvement. Standardized EUS protocols are warranted to enhance LN staging accuracy.