Determining the Extent of Cholecystectomy using Intraoperative Specimen
Ultrasonography in Patients with Suspected Early Gallbladder Cancer
Supplementary Materials
Fig. E1a
Fig. E1 Preparation of a gallbladder specimen. a A gallbladder specimen was pinned on flat
corks bars with the mucosal side facing down. Saline was used to provide the medium for
ultrasound transmission. b The specimen was scanned with a linear hockey-stick transducer
operating at an ultrasound frequency of 18 megahertz
Fig. E1b
Fig. E1 Preparation of a gallbladder specimen. a A gallbladder specimen was pinned on flat
corks bars with the mucosal side facing down. Saline was used to provide the medium for
ultrasound transmission. b The specimen was scanned with a linear hockey-stick transducer
operating at an ultrasound frequency of 18 megahertz
Fig. E2
Fig. E2 Benign tubular adenoma in a 42-year-old male. Specimen ultrasonography image of a
42-year-old male showing a homogenous echoic mass with a smooth margin, in which the
attachment to the gallbladder wall was barely perceptible
Fig. E3
Fig. E3 T1b gallbladder cancer in a 74-year old female. The specimen ultrasonography image
shows a hypoechoic attachment (arrowheads), and a dimpling in the inner layer (arrow)
Fig. E4a
Fig. E4 T1b gallbladder cancer in a 67-year-old female. a A contrast-enhanced transverse CT
image shows a homogenously enhancing mass in the gallbladder. b The specimen
ultrasonography image shows a mass with a hypoechoic attachment to the gallbladder wall
(arrowheads). A focal dimpling is visible at the outer margin of the inner hypoechoic layer
(arrow). c The mass was confirmed as a T1b gallbladder cancer on permanent pathology.
Note the dimple (arrow) of the muscularis propria (dotted line)
Fig. E4b
Fig. E4 T1b gallbladder cancer in a 67-year-old female. a A contrast-enhanced transverse CT
image shows a homogenously enhancing mass in the gallbladder. b The specimen
ultrasonography image shows a mass with a hypoechoic attachment to the gallbladder wall
(arrowheads). A focal dimpling is visible at the outer margin of the inner hypoechoic layer
(arrow). c The mass was confirmed as a T1b gallbladder cancer on permanent pathology.
Note the dimple (arrow) of the muscularis propria (dotted line)
Fig. E4c
Fig. E4 T1b gallbladder cancer in a 67-year-old female. a A contrast-enhanced transverse CT
image shows a homogenously enhancing mass in the gallbladder. b The specimen
ultrasonography image shows a mass with a hypoechoic attachment to the gallbladder wall
(arrowheads). A focal dimpling is visible at the outer margin of the inner hypoechoic layer
(arrow). c The mass was confirmed as a T1b gallbladder cancer on permanent pathology.
Note the dimple (arrow) of the muscularis propria (dotted line)
Fig. E5a
Fig. E5 T2 gallbladder cancer in a 76-year-old male. a The contrast-enhanced transverse CT
image shows stones in the collapsed gallbladder. The diffuse wall thickening of the collapsed
gallbladder may be indicative of chronic cholecystitis; however, an asymmetric enhancement
of the fundal wall raised the concern of gallbladder cancer. b The specimen ultrasonography
image shows a thickening of the inner hypoechoic layer invading the outer hyperechoic layer
(arrow). c Permanent pathology slide shows tumor cells invading the perimuscular connective
tissue layer (arrows)
Fig. E5b
Fig. E5 T2 gallbladder cancer in a 76-year-old male. a The contrast-enhanced transverse CT
image shows stones in the collapsed gallbladder. The diffuse wall thickening of the collapsed
gallbladder may be indicative of chronic cholecystitis; however, an asymmetric enhancement
of the fundal wall raised the concern of gallbladder cancer. b The specimen ultrasonography
image shows a thickening of the inner hypoechoic layer invading the outer hyperechoic layer
(arrow). c Permanent pathology slide shows tumor cells invading the perimuscular connective
tissue layer (arrows)
Fig. E5c
Fig. E5 T2 gallbladder cancer in a 76-year-old male. a The contrast-enhanced transverse CT
image shows stones in the collapsed gallbladder. The diffuse wall thickening of the collapsed
gallbladder may be indicative of chronic cholecystitis; however, an asymmetric enhancement
of the fundal wall raised the concern of gallbladder cancer. b The specimen ultrasonography
image shows a thickening of the inner hypoechoic layer invading the outer hyperechoic layer
(arrow). c Permanent pathology slide shows tumor cells invading the perimuscular connective
tissue layer (arrows)