Ultrasound is the recommended initial imaging modality for the evaluation of suspected gallbladder malignancy in primary care, as it is the first-line investigation for suspected gallbladder disease and can identify abnormalities in the gallbladder and biliary tree.
Magnetic resonance cholangiopancreatography (MRCP) should be considered if ultrasound findings are inconclusive, especially if there is bile duct dilatation or abnormal liver function tests, to further evaluate the biliary system.
Endoscopic ultrasound (EUS) may be considered if MRCP does not provide a definitive diagnosis.
These imaging steps help differentiate gallbladder malignancy from other gallbladder diseases and guide referral for further specialist assessment.
Therefore, the initial evaluation pathway in primary care involves ultrasound first, followed by MRCP and possibly EUS if needed.
NICE CG188