 This is Dr. Himanshu Pruthi, senior resident from department of PJMR Chandigarh. I thank Sonogas to present, to let me present my work as a total scientific presentation at the conference 2023. The topic of my presentation is survey sign. So can it be a new ancillary sonographic pattern for early depiction of GB Melignancy? As we know, we all know that GB Melignancy is one of the very common aggressive and commonly found Melignancy, most common type among, especially in India. And it carries a very poor prognosis and its early diagnosis will always help in improving the survival. The other two types like mass common polypolytypes are easily diagnosed with the wordable imaging Melignancy. So we are mainly concentrated on GB wall thickening type of GB cuts, which poses a challenge. Even having a multi-modality approach, like we have a CCT where CT scan the data has been described as multi-layered enhancement and as by Kim et al. And on MRA also there is better depiction of the GB gallstones and the invasion of the GB Melignancy, I think GB wall thickening into the adjacent lever pan timer. And as the primary screening tool for ultrasound is one of the most important part and it is easily, it can be easily confused and missed with as acute polycystitis from the GB Melignancy, especially in the neck region. So there are certain recent responses also like speckle imaging, speckle reduction and harmonic imaging, high-frequency transducers also there. Even after so much of that, there is very much difficulty in diagnosis of GB neck cancer and GB wall thickening. So we have a diagnostic performance of a sign which we are giving it name as a cervix sign, which is defined as one of the longitudinal ultrasound when we are seeing a symmetrical or asymmetric neural thickening at neck region with a central interface or you can say a small human which may be fluid filled or collapsed in an otherwise distant GB which may be mimicking at which mimic as cervix. So this cervix sign and we are seeing cases of malignant as a benign GB wall thickening at neck region and then describing the cervix sign and seeing its efficacy. So it is a single waste sign, it is one year, four months between August 2020 to December 21 at PJMR Chandigarh department and we are thinking patients who had GB malignancy for analysis in this group and the diagnosis for the malignant cases were histopathological whereas for the benign cases it was either their lack of progression on six month follow or there was histopathological diagnosis. Inclusion criteria, the patients who are, the adult patients who are having GB wall thickening and which are suspicious for GB carcinoma ultrasound and exclusion criteria is the pediatric age less than 60, 18 years, GB mass or metastatic diseases or other diseases which is having a GB which makes the GB un-evaluable like having gallbladder contracted or gallbladder calcoli with posterior plastic shadowing obscuring the details of the neck region or follicose shadow complex bowel gases obscuring the disease. So the study contained of 228 cases of GB wall thickening and our neck cohort came out to be 75 out of the 10 excluded due to contracted and impacted stones with 65 as final count for GB wall thickening. So there was a retrospective analysis of cervix sign and after the retrospective you see a diagnostic performance of this sign between benign and malignant cases. So ultrasound were independently reviewed for cervix sign by two radiologists of two and four years of experiences and there are, it was done on logic acid scanner and morphological feature were also studied as a security layer like liver pancom involvement, layer difference of gallbladder intramural acrobatic thickening, the cutoff for the thickening was taken as to be more than 3 m. So the division of malignant GB was divided into two groups with the cervix sign and without cervix sign and various stat analysis were put in that in the SPSS stat analysis and inter-observer agreement for cervix sign was calculated using cohen's kappa stats. So p value less than 0.05 was taken as significant and the t tests and chi-square official to exact test were taken. So the results are as follows. So the mean age was 55 years and there was no difference between the age or the gender between the benign and malignant. The cervix sign was taken two-third of the patient in the malignant cases whereas only one in the benign cases. And out of these cases, 18 cases what we have found, the 17 malignant and one benign, what we have found that there was mean GB wall thickening was more common in GBCA with cervix sign than without cervix sign. However, the difference was not statistically significant. So these are the age and gender demography and where we are, these are the findings characteristic, different characteristics and in this I want to highlight just about the asymmetric wall thickening and symmetric wall thickening are more common in group A that is with the cervix sign. And these are the sign, this is the group which is mostly malignant. So this shows the importance of having more as obviously there will be more malignancy has more progression and there will be more constriction at the neck region causing these signs more easily depictable on ultrasound. So this is our known cervix sign and this is the known cervix sign and you can see that this is a known cervix sign or pyloric hypertrophy as described earlier where we are having a thickening at the pyloric region which is mimicking like cervix. So here we are proposing that a neck, GB neck malignancy which is may mimic as cervix sign with distended lumen in between that are distended lumen and central lumen which may be flowed like in this case or which may be effaced like in this phase. And here also you can see that the thickening at the neck region is mimicking as GB neck malignancy. So again in this we can see the central lumen, the black note is effaced and there is a thickening at the GB neck region. Now the importance of this is cervix sign may be useful and should be signed for malignant theory because now we see that on ultrasound when we see there is a normal statement that once we are seeing a distended GB, always suspect a GB neck calculate that is one of the things. So similarly once we are seeing a distended GB and thickening at GB neck region we have to suspect a malignancy and that is why we are having a mindset of thinking in terms of GB cervix sign and this can be more prospective studies have to be taken for its role to be diagnosis of early diagnosis of GB cancer. These are my references and I thank you very much for that, giving me opportunity. Thank you.