European Journal of Cardiovascular Medicine

Nearly 9% of all the subjects admitted to healthcare facility with abdominal pain have diagnosis of acute cholecystitis and need urgent surgical intervention. However, not all the subjects that present with fever have increased counts of WBCs (white blood cells). Acute biliary pain is one of the most common symptoms of gallbladder disease and typically present as abdominal pain in the right upper quadrant and epigastrium within half an hour to one hour after the meals.¹

The gold standard management for confirmed cases of cholecystitis progression is cholecystectomy as an untreated case, symptomatic biliary disease progress to complications and increase the risk of mortality. Ultrasound is considered as a helpful toll for making and exclusion of the diagnosis of cholecystitis. However, distinguishing acute cholecystitis from chronic is complicated owing to overlapping findings on the ultrasound.²

Ultrasonography presents a sensitivity and specificity of nearly 90%. Multiple indicators on ultrasonography for acute cholecystitis are being explained including distension of gall bladder, thickening of the wall of gallbladder, pericholecystic fluid, a stone wedged in the gallbladder neck, Murphey’s sign on ultrasonography, and presence of stones. Abdominal ultrasonography has various limitations as posterior acoustic shadowing, limited depth resolution, and interference by bowel gas in presence of calculi.³

Hence, the ability of ultrasonography in prediction of acute cholecystitis in subjects with presence of clinical symptoms is limited.⁴ Hence, the present study was aimed to assess the correlation between ultrasonography and histopathological efficacy in subjects with pathology of the gall bladder.

The present cross-sectional clinical study was aimed to assess the correlation between ultrasonography and histopathological efficacy in subjects with pathology of the gall bladder. The study subjects were from Department of Pathology of the Institute. Verbal and written informed consent were taken from all the subjects before study participation.

The present study assessed 208 subjects that underwent histopathological assessment and ultrasonographic abdominal scans. Clinical and demographic data were gathered along with the assessment of serum bilirubin levels.

The inclusion criteria for the study were subjects that were subjects that were diagnosed with cholecystitis or cholelithiasis from both the genders, aged 21 to 70 years, and underwent ultrasonography of the abdomen along with histopathological assessment, and serum bilirubin level estimation. The exclusion criteria for the study were subjects that were subjects with autolysed cholecystectomy specimens and subjects that did not give consent for study participation.

The collected data were subjected to statistical evaluation using the chi-square test, Fisher’s exact test, Mann Whitney U test, and SPSS (Statistical Package for the Social Sciences) software version 24.0 (IBM Corp., Armonk. NY, USA) using ANOVA, chi-square test, and student's t-test. The significance level was considered at a p-value of <0.05. Also, kappa agreement test was used for assessment of inter-rater agreement in various diagnostic methods.

The present cross-sectional clinical study was aimed to assess the correlation between ultrasonography and histopathological efficacy in subjects with pathology of the gall bladder. The present study assessed 208 subjects that underwent histopathological assessment and ultrasonographic abdominal scans. Clinical and demographic data were gathered along with the assessment of serum bilirubin levels. There were 69.5% (n=32) males and 30.4% (n=14) females in subjects with cholecystitis without cholelithiasis and 71.6% (n=116) males and 28.40% (n=46) females in Cholecystitis with cholelithiasis group. The difference was statistically non-significant with p=0.82. The age range among two study groups was statistically non-significant with p=0.31 (Table 1).

Table 1: Demographic and clinical data of study subjects

It was seen that for serum bilirubin levels in the study subjects, direct serum bilirubin level was normal in 8.70% (n=4) subjects, abnormal (0.3-1.1) in 78.2% (n=36), and abnormal (1.1-1.9) in 13.04% (n=6) study subjects with cholecystitis without cholelithiasis. Serum bilirubin level was normal in 2.4% (n=4), abnormal (0.3-1.1) in 82.7% (n=134), and abnormal (1.1-1.9) in 14.8% (n=24) study subjects with cholecystitis with cholelithiasis. The results were statistically non-significant with p=0.36. Total normal level was seen in 82.6% (n=38) and abnormal in 17.3% (n=8) subjects with abnormal total bilirubin level in group of cholecystitis without cholelithiasis. In subjects having Cholecystitis with cholelithiasis, total normal bilirubin level was seen in 39.5% (n=64) and abnormal in 60.4% study subjects respectively. The difference was statistically significant with p=0.0004 (Table 2).

Table 2: Serum bilirubin levels in the study subjects

Table 3: Correlation of histopathological examination to ultrasonography findings

The study results showed that for correlation of histopathological examination to ultrasonography findings, correlation was seen in no subjects having Cholecystitis without cholelithiasis and in 156 subjects having Cholecystitis with cholelithiasis. In subjects having Cholecystitis without cholelithiasis, correlation was seen in 46 subjects and in 6 subjects for Cholecystitis with cholelithiasis. The kappa agreement was 0.918 with the range of (0.829-1.000) (Table 2). For correlation of histopathological examination to serum bilirubin levels, correlation was seen in 38 subjects with normal serum bilirubin levels to histopathological Cholecystitis without cholelithiasis and in 64 subjects having Cholecystitis with cholelithiasis. In subjects with abnormal serum bilirubin levels, correlation with histopathology was seen in 8 subjects having Cholecystitis without cholelithiasis and 98 subjects having Cholecystitis with cholelithiasis. The kappa agreement was 0.893 with the range of (0.792-0.993) (Table 4).

Table 4: Correlation of histopathological examination to bilirubin levels

On assessing the USG and histopathological findings in study subjects, kappa agreement was 1.000 (1.000-1.000) for USG findings and serum bilirubin levels. For normal and abnormal serum bilirubin levels, kappa agreement was seen as 0.893 (0.792-0.993) for subjects with cholecystitis and cholelithiasis. For correlation of ultrasonography findings in subjects with cholecystitis and cholelithiasis, kappa agreement was 0.918 (0.833-1.000) (Table 5).

Table 5: USG and histopathological findings in study subjects

The present study assessed 208 subjects that underwent histopathological assessment and ultrasonographic abdominal scans. Clinical and demographic data were gathered along with the assessment of serum bilirubin levels. There were 69.5% (n=32) males and 30.4% (n=14) females in subjects with cholecystitis without cholelithiasis and 71.6% (n=116) males and 28.40% (n=46) females in Cholecystitis with cholelithiasis group. The difference was statistically non-significant with p=0.82. The age range among two study groups was statistically non-significant with p=0.31. These data were comparable to the previous studies of Malik MM et al⁵ in 2020 and Bekele Z et al⁶ in 2002 where authors assessed subjects with demographic data comparable to the present study in their respective studies.

The study results showed that for serum bilirubin levels in the study subjects, direct serum bilirubin level was normal in 8.70% (n=4) subjects, abnormal (0.3-1.1) in 78.2% (n=36), and abnormal (1.1-1.9) in 13.04% (n=6) study subjects with cholecystitis without cholelithiasis. Serum bilirubin level was normal in 2.4% (n=4), abnormal (0.3-1.1) in 82.7% (n=134), and abnormal (1.1-1.9) in 14.8% (n=24) study subjects with cholecystitis with cholelithiasis. The results were statistically non-significant with p=0.36. Total normal level was seen in 82.6% (n=38) and abnormal in 17.3% (n=8) subjects with abnormal total bilirubin level in group of cholecystitis without cholelithiasis. In subjects having Cholecystitis with cholelithiasis, total normal bilirubin level was seen in 39.5% (n=64) and abnormal in 60.4% study subjects respectively. The difference was statistically significant with p=0.0004. These results were consistent with the findings of Mazlum M et al⁷ in 2011 and Kushwah AP et al⁸ in 2018 where results for serum bilirubin levels reported by the authors in their studies was comparable to the results of the present study.

It was seen that for correlation of histopathological examination to ultrasonography findings, correlation was seen in no subjects having Cholecystitis without cholelithiasis and in 156 subjects having Cholecystitis with cholelithiasis. In subjects having Cholecystitis without cholelithiasis, correlation was seen in 46 subjects and in 6 subjects for Cholecystitis with cholelithiasis. The kappa agreement was 0.918 with the range of (0.829-1.000) (Table 2). For correlation of histopathological examination to serum bilirubin levels, correlation was seen in 38 subjects with normal serum bilirubin levels to histopathological Cholecystitis without cholelithiasis and in 64 subjects having Cholecystitis with cholelithiasis. In subjects with abnormal serum bilirubin levels, correlation with histopathology was seen in 8 subjects having Cholecystitis without cholelithiasis and 98 subjects having Cholecystitis with cholelithiasis. The kappa agreement was 0.893 with the range of (0.792-0.993). These findings were in agreement with the results of Mahajan V et al⁹ in 2018 and Wadhwa V et al¹⁰ in 2017 where correlation of histopathological examination to ultrasonography findings and correlation of histopathological examination to serum bilirubin levels similar to the present study was also reported by the authors in their studies.

Concerning the assessment of the USG and histopathological findings in study subjects, kappa agreement was 1.000 (1.000-1.000) for USG findings and serum bilirubin levels. For normal and abnormal serum bilirubin levels, kappa agreement was seen as 0.893 (0.792-0.993) for subjects with cholecystitis and cholelithiasis. For correlation of ultrasonography findings in subjects with cholecystitis and cholelithiasis, kappa agreement was 0.918 (0.833-1.000). These results corelated with the findings of Bundgaard NS et al¹¹ in 2021 and Kaur T et al¹² in 2025 where results for USG and histopathological findings in subjects with cholecystectomy and cholelithiasis reported by the authors in their studies was comparable to the results of the present study.

The present study, within its limitations, concludes that serum bilirubin and ultrasonography as a combination marker approach presents a versatile tool for intervention guidance and quick decision-making tool in cases of biliary tract. Further, longitudinal studies with larger sample size and longer monitoring are needed to reach a definitive conclusion.

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