Abstract: Objective To evaluate the diagnostic value of contrast-enhanced ultrasound combined with serum soluble T cell immunoglobulin mucin-3 (sTIM-3) and YKL-40 levels in differentiating malignant and benign gallbladder lesions. Methods A total of 320 patients with gallbladder occupying lesions admitted to Handan People's Hospital from May 2021 to November 2023 were selected. According to postoperative pathological results, patients were divided into a benign group (262 cases) and a malignant group (58 cases). All patients underwent routine and contrast-enhanced ultrasound examinations, and serum sTIM-3 and YKL-40 level testing. Clinical characteristics and detection indicators were compared between the two groups. Results Two-dimensional ultrasound showed that the proportions of irregular lesion shapes, multiple lesion numbers, and liver infiltration in the malignant group were 74.14%, 81.03%, and 43.10%, respectively, which were higher than those in the benign group (23.28% , 46.56%, and 0.00%, respectively) (P<0.05). There was no significant difference in the comparison of combined gallbladder stones between the two groups (P>0.05). Contrast-enhanced ultrasound showed that there was no significant difference in the enhancement levels during the arterial phase between the two groups (P>0.05). In terms of distribution characteristics, the proportion of uniform distribution in the benign group was 73.66% , which was higher than that in the malignant group (56.90%) (P<0.05). In terms of the enhancement level during the venous phase, the proportion of low-level enhancement in the malignant group was 82.76%, which was higher than that in the benign group (7.25%) (P<0.05). In terms of the integrity of the gallbladder wall, the proportion of the integrity of the gallbladder wall in the benign group was 95.80% , which was higher than that in the malignant group (53.45% ) (P<0.05). In terms of the lesion base, the proportion of wide-type lesions in the benign group was 46.95% , which was lower than that in the malignant group (96.55%)(P<0.05). The serum sTIM-3 and YKL-40 levels in the malignant group were (3.20 ± 1.18) ng/mL and (247.48 ± 54.85) ng/mL, respectively, which were higher than those in the benign group [(1.71 ± 0.52) ng/mL and (168.80 ± 34.19) ng/mL, respectively] (P<0.01). ROC curve analysis showed that the sensitivity of contrast-enhanced ultrasound for diagnosing malignant and benign gallbladder lesions was 82.8%, with a specificity of 92.7% and an AUC of 0.898. The sensitivity for serum sTIM-3 was 81.0%, specificity 88.2%, and AUC 0.883. For YKL-40, the sensitivity was 82.8%, specificity 84.0%, and AUC 0.891. When combining contrast-enhanced ultrasound with sTIM-3 and YKL-40, sensitivity increased to 91.4%, specificity reached 98.1%, and the AUC value was 0.966. Conclusion The detection of contrast-enhanced ultrasound combined with serum sTIM-3 and YKL-40 levels can significantly improve the accuracy of differentiating between benign and malignant gallbladder lesions, providing a reliable reference for clinical practice.

Key words: Contrast-enhanced ultrasound, Gallbladder lesions, Soluble T cell immunoglobulin mucin-3, YKL-40, Differentiation of benign and malignant lesions