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Ibrahim MA, El Kouzi Z, Hachicho F, Kobeissi L, Ahmad JH, Sharara AI. Real-World Management and Economic Burden of Gallbladder Polyps. J Clin Gastroenterol 2025:00004836-990000000-00449. [PMID: 40372986 DOI: 10.1097/mcg.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Accepted: 04/14/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Gallbladder polyps (GBP) are found incidentally on imaging in ∼5% of the general population. Most are asymptomatic and only a very small percentage are malignant. This study examines real-world clinical practice management of GBP and adherence to the updated joint European guidelines. METHODS Patients with GBP between January 2019 and October 2022 were included. Clinical, radiologic, and surgical data were collected retrospectively. RESULTS One hundred thirty-eight patients were included (mean age 47.0±14.1; female 46.4%). The average follow-up period was 30.6±40.8 months. During the study period, only 26.0% of patients had an increase in GBP size. There were no predictors for GBP growth. Cholecystectomy was performed in 30 patients: 19 (63.3%) had GBP as the indication, and in those, only 9/19 (47.4%) had proper indications according to guidelines. No malignant polyps were found, and no GBP-related deaths were reported. Increased polyp size (P<0.0001) and number (P=0.014) during follow-up were significantly associated with cholecystectomy. Of the 104 patients who did not have surgery, 70 (67.3%) had no indication for follow-up imaging, but 42 (60%) were advised to continue follow-up. The average increased cost of guideline-inconsistent follow-up imaging was >$51,000 and >$67,000 for unindicated cholecystectomies, bringing total waste expenditures to >$118,000. CONCLUSION The natural history of GBP does not justify close or prolonged follow-up, especially in young individuals without risk factors. Poor adherence to guidelines by radiologists, gastroenterologists, surgeons, and other health care providers should be addressed, offering a real opportunity for medical education and significant health care savings.
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Affiliation(s)
- Mohamad Ali Ibrahim
- Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
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Chang W, Lee S, Kim YY, Park JY, Jeon SK, Lee JE, Yoo J, Han S, Park SH, Kim JH, Park HJ, Yoon JH. Interpretation, Reporting, Imaging-Based Workups, and Surveillance of Incidentally Detected Gallbladder Polyps and Gallbladder Wall Thickening: 2025 Recommendations From the Korean Society of Abdominal Radiology. Korean J Radiol 2025; 26:102-134. [PMID: 39898393 PMCID: PMC11794292 DOI: 10.3348/kjr.2024.0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/29/2024] [Accepted: 11/01/2024] [Indexed: 02/04/2025] Open
Abstract
Incidentally detected gallbladder polyps (GBPs) and gallbladder wall thickening (GBWT) are frequently encountered in clinical practice. However, characterizing GBPs and GBWT in asymptomatic patients can be challenging and may result in overtreatment, including unnecessary follow-ups or surgeries. The Korean Society of Abdominal Radiology (KSAR) Clinical Practice Guideline Committee has developed expert recommendations that focus on standardized imaging interpretation and follow-up strategies for both GBPs and GBWT, with support from the Korean Society of Radiology and KSAR. These guidelines, which address 24 key questions, aim to standardize the approach for the interpretation of imaging findings, reporting, imaging-based workups, and surveillance of incidentally detected GBPs and GBWT. This recommendation promotes evidence-based practice, facilitates communication between radiologists and referring physicians, and reduces unnecessary interventions.
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Affiliation(s)
- Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seungchul Han
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
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Foley KG, Riddell Z, Coles B, Roberts SA, Willis BH. Risk of developing gallbladder cancer in patients with gallbladder polyps detected on transabdominal ultrasound: a systematic review and meta-analysis. Br J Radiol 2022; 95:20220152. [PMID: 35819918 PMCID: PMC10996949 DOI: 10.1259/bjr.20220152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/14/2022] [Accepted: 07/06/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To estimate the risk of malignancy in gallbladder polyps of incremental sizes detected during transabdominal ultrasound (TAUS). METHODS We searched databases including MEDLINE, Embase, and Cochrane Library for eligible studies recording the polyp size from which gallbladder malignancy developed, confirmed following cholecystectomy, or by subsequent follow-up. Primary outcome was the risk of gallbladder cancer in patients with polyps. Secondary outcome was the effect of polyp size as a prognostic factor for cancer. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Bayesian meta-analysis estimated the median cancer risk according to polyp size. This study is registered with PROSPERO (CRD42020223629). RESULTS 82 studies published since 1990 reported primary data for 67,837 patients. 67,774 gallbladder polyps and 889 cancers were reported. The cumulative median cancer risk of a polyp measuring 10 mm or less was 0.60% (99% credible range 0.30-1.16%). Substantial heterogeneity existed between studies (I2 = 99.95%, 95% credible interval 99.86-99.98%). Risk of bias was generally high and overall confidence in evidence was low. 13 studies (15.6%) were graded with very low certainty, 56 studies (68.3%) with low certainty, and 13 studies (15.6%) with moderate certainty. In studies considered moderate quality, TAUS monitoring detected 4.6 cancers per 10,000 patients with polyps less than 10 mm. CONCLUSION Malignant risk in gallbladder polyps is low, particularly in polyps less than 10 mm, however the data are heterogenous and generally low quality. International guidelines, which have not previously modelled size data, should be informed by these findings. ADVANCES IN KNOWLEDGE This large systematic review and meta-analysis has shown that the mean cumulative risk of small gallbladder polyps is low, but heterogeneity and missing data in larger polyp sizes (>10 mm) means the risk is uncertain and may be higher than estimated.Studies considered to have better methodological quality suggest that previous estimates of risk are likely to be inflated.
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Affiliation(s)
- Kieran G Foley
- Division of Cancer & Genetics, School of Medicine, Cardiff
University, Cardiff,
UK
| | - Zena Riddell
- National Imaging Academy of Wales (NIAW),
Pencoed, UK
| | - Bernadette Coles
- Velindre University NHS Trust Library & Knowledge
Service, Cardiff,
UK
| | - S Ashley Roberts
- Department of Clinical Radiology, University Hospital of
Wales, Cardiff,
UK
| | - Brian H Willis
- Institute of Applied Health Research, University of
Birmingham, Birmingham,
UK
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Diep R, Lombardo P, Schneider M. The growth rates of solitary gallbladder polyps compared to multi‐polyps: A quantitative analysis. Australas J Ultrasound Med 2021; 25:28-35. [DOI: 10.1002/ajum.12284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Raymond Diep
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
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Ma NQ, Lv HY, Bi J, Yu FX, Huang XM. Scoring system for gallbladder polyps based on the cross-sectional area and patient characteristics. Asian J Surg 2021; 45:332-338. [PMID: 34147329 DOI: 10.1016/j.asjsur.2021.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Current management guidelines for gallbladder polyps (GBPs) focus on a diameter more than 1 cm as an indication for cholecystectomy. Since most GBPs are not malignant, unnecessary cholecystectomies can lead to unnecessary complications and costs. We developed a score to identify true polyps focusing on their cross-sectional area (CSA). METHODS We retrospectively analyzed the demographic, clinical, laboratory, and sonographic characteristics of 522 patients with GBPs who had undergone cholecystectomy at our hospital between January 2010 and July 2020 (reference group). We used univariate analysis to compare these parameters between 88 true polyps and 434 pseudopolyps and multivariate logistic regression analysis to identify parameters to include in our scoring model. Receiver operating characteristics and area under the curve were used to identify cut-off values. The model was tested on a validation group of 98 patients. RESULTS In the multivariate analysis, a CSA >123 mm2, positive blood flow signal, age >55.5 years, alanine aminotransferase (ALT) levels > 50 U/L, and an ALT/aspartate aminotransferase ratio > 0.77 were significantly associated with true polyps (odds ratio 6.528, 2.377, 2.617, 2.445, and -0.372, respectively). A prediction model based on cut-off values was used to distinguish a low-risk and high-risk GBP group; true polyps accounted for 6.54% and 58.72%, respectively (p < 0.001). In the low-risk and high-risk validation groups, true polyps comprised 12.35% and 82.35%, respectively (p < 0.001). CONCLUSIONS Our scoring system shows high accuracy and specificity in identifying true polyps and helps determine the need for surgical resection.
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Affiliation(s)
- Nai-Qing Ma
- Department of Hepatological Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao-Yang Lv
- Department of Hepatological Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiayang Bi
- Department of Hepatological Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fu-Xiang Yu
- Department of Hepatological Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xia-Ming Huang
- Department of Hepatological Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Zhang D, Li Q, Zhang X, Jia P, Wang X, Geng X, Zhang Y, Li J, Yao C, Liu Y, Guo Z, Yang R, Lei D, Yang C, Hao Q, Yang W, Geng Z. Establishment of a nomogram prediction model for long diameter 10-15 mm gallbladder polyps with malignant tendency. Surgery 2021; 170:664-672. [PMID: 34090677 DOI: 10.1016/j.surg.2021.04.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency. METHODS Clinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted. RESULTS Excluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CEA and CA19-9 levels, number of polyps, fundus, echogenicity, gallbladder wall thickness and postoperative pathologic features (P < .05). Among 588 patients with gallbladder polyps with a long diameter of 10 of 15 mm, multivariate analysis indicated the following independent risk factors of gallbladder polyps with malignant tendency: single polyps (OR = 0.286/P < .001), polyps with broad base (OR = 2.644/P = .001), polyps with medium/low echogenicity (OR = 2.387/P = .003), and polyps with short diameter of 7 to 9 or 10 to 15 mm (OR = 3.820/P = .005; OR = 2.220/P = .048, respectively). The C-index of the nomogram model and internal validation were .778 and .768, respectively. In addition, a sample online calculator for the nomogram prediction model had been created (https://docliqi.shinyapps.io/dynnom/). CONCLUSION Indications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.
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Affiliation(s)
- Dong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaodi Zhang
- Department of Hepatobiliary Surgery, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Pengbo Jia
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, China
| | - Xintuan Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, China
| | - Xilin Geng
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Junhui Li
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chunhe Yao
- Department of General Surgery, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Yimin Liu
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, China
| | - Zhihua Guo
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, China
| | - Rui Yang
- Department of General Surgery, Central Hospital of Hanzhong City, Hanzhong, China
| | - Da Lei
- Department of Hepatobiliary Surgery, Central Hospital of Baoji City, Baoji, China
| | - Chenglin Yang
- Department of General Surgery, Central Hospital of Ankang City, Ankang, China
| | - Qiwei Hao
- Department of Hepatobiliary Surgery, The Second Hospital of Yulin City, Yulin, China
| | - Wenbin Yang
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhimin Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Zhu L, Han P, Lee R, Jiang B, Jiao Z, Li N, Tang W, Fei X. Contrast-enhanced ultrasound to assess gallbladder polyps. Clin Imaging 2021; 78:8-13. [PMID: 33706069 DOI: 10.1016/j.clinimag.2021.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. METHODS A total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. RESULTS There were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. CONCLUSION Vascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.
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Affiliation(s)
- Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Regis Lee
- Department of Ultrasound in Research and Education, Rocky Vista University, 255 East Center Street, Room C286, Ivins, UT 84738, USA
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Ziyu Jiao
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Wenbo Tang
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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Yu L, Li N, Zhang XM, Wang T, Chen W. Analysis of 234 cases of colorectal polyps treated by endoscopic mucosal resection. World J Clin Cases 2020; 8:5180-5187. [PMID: 33269254 PMCID: PMC7674734 DOI: 10.12998/wjcc.v8.i21.5180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colorectal polyps refer to all neoplasms that protrude into the intestinal cavity. Researchers believe that 50%-70% of colorectal cancers originate from adenomatous polyps. AIM To investigate the endoscopic morphologic features, pathologic types, and clinical situation; evaluate the efficacy and safety of endoscopic mucosal resection (EMR); and guide clinicians in their daily practice. METHODS Two hundred thirty-four patients who underwent EMR in our hospital from January 1, 2018 to December 31, 2019 were recruited. Data including sex, age, endoscopic morphology of the polyps, and pathological characteristics were analyzed among groups. RESULTS A total of 295 polyps were resected from the 234 subjects enrolled in the study, of which 4 (1.36%) were Yamada type I. There were 75 (25.42%) type II, 101 (34.24%) type III, and 115 (38.98%) type IV adenomas. Among them, 41 were non-adenomas, 110 were low-risk adenomas, 139 were high-risk adenomas, and 5 were carcinomas. The differences in distribution were not statistically significant, with P values greater than 0.05. The risk of cancer significantly increased for polyps ≥ 1 cm in diameter (c2 = 199.825, P = 0.00). Regarding the endoscopic morphological features, congestion, erosion, and lobulation were more common on the surface morphology of high-risk adenomas and cancerous polyps (c2 = 75.257, P = 0.00), and most of them were Yamada types III and IV. In all, 6 of the 295 polyps could not be removed completely, with a one-time resection rate of 97.97%. There were two cases of postoperative bleeding and no cases of perforation, with an overall complication rate of 0.09%. CONCLUSION Colorectal polyps ranging from non-adenomatous polyps, low-risk adenomas, and high-risk adenomas to adenocarcinomas each has their own endoscopic features, while EMR, as a mature intervention, has good safety and operability and should be promoted clinically, especially at the primary care level.
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Affiliation(s)
- Lu Yu
- Department of Gastroenterology, Maanshan Central Hospital, Maanshan 243000, Anhui Province, China
| | - Na Li
- Department of Gastroenterology, Affiliated Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Xiao-Mei Zhang
- Department of Gastroenterology, Maanshan Central Hospital, Maanshan 243000, Anhui Province, China
| | - Tao Wang
- Department of Gastroenterology, Maanshan Central Hospital, Maanshan 243000, Anhui Province, China
| | - Wei Chen
- Department of Gastroenterology, Maanshan Central Hospital, Maanshan 243000, Anhui Province, China
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Valibouze C, El Amrani M, Truant S, Leroy C, Millet G, Pruvot FR, Zerbib P. The management of gallbladder polyps. J Visc Surg 2020; 157:410-417. [PMID: 32473822 DOI: 10.1016/j.jviscsurg.2020.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoplastic gallbladder polyps (NGP) are rare; the prevalence in the overall population is less than 10%. NGP are associated with a risk of malignant degeneration and must be distinguished from other benign gallbladder polypoid lesions that occur more frequently. NGP are adenomas and the main risk associated with their management is to fail to detect their progression to gallbladder cancer, which is associated with a particular poor prognosis. The conclusions of the recent European recommendations have a low level of evidence, based essentially on retrospective small-volume studies. Abdominal sonography is the first line study for diagnosis and follow-up for NGP. To prevent the onset of gallbladder cancer, or treat malignant degeneration in its early phases, all NGP larger than 10mm, or symptomatic, or larger than 6mm with associated risk factors for cancer (age over 50, sessile polyp, Indian ethnicity, or patient with primary sclerosing cholangitis) are indications for cholecystectomy. Apart from these situations, simple sonographic surveillance is recommended for at least five years; if the NGP increases in size by more than 2mm in size, cholecystectomy is indicated. Laparoscopic cholecystectomy is possible but if the surgeon feels that the risk of intra-operative gallbladder perforation is high, conversion to laparotomy should be preferred to avoid potential intra-abdominal tumoral dissemination. When malignant NGP is suspected (size greater than 15mm, signs of locoregional extension on imaging), a comprehensive imaging workup should be performed to search for liver extension: in this setting, radical surgery should be considered.
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Affiliation(s)
- C Valibouze
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France.
| | - M El Amrani
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - S Truant
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - C Leroy
- Department of Radiology and Digestive and Endocrine Imaging, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, 59037 Lille, France
| | - G Millet
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - F R Pruvot
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - P Zerbib
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
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Smereczyński A, Kołaczyk K, Bernatowicz E. Optimization of diagnostic ultrasonography of the gallbladder based on own experience and literature. J Ultrason 2020; 20:e29-e35. [PMID: 32320550 PMCID: PMC7266065 DOI: 10.15557/jou.2020.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/13/2019] [Indexed: 12/07/2022] Open
Abstract
Although transabdominal imaging of the gallbladder has become a gold standard, new light should be shed on some aspects, which will prove useful in everyday practice. Therefore, based on our own experience and the available literature, we would like to draw attention to those elements of gallbladder ultrasound imaging which may increase its diagnostic efficacy. The paper draws attention to the difficulty in assessing certain anatomical structures, such as the inferior wall, the bottom and the region of the neck of the gallbladder, and offers ways to improve their imaging. We also emphasized the negative effects of duodenal and transverse colon (along with their contents) adhesion to the bottom of the gallbladder on the correct diagnosis. Due to the importance of size in the management strategy for detected gallbladder polyps, we suggest their measurement on an image enlarged with the zoom function. This technique also allows for an accurate assessment of the shape and echostructure of these lesions. An enlarged image of a polyp makes it possible to trace its behavior in time. We also remind that the hepatic wall of the gallbladder is the only site allowing for a reliable wall thickness measurement. We also pointed to the importance of changing patient's position when assessing the mobility and the nature of lesions. Altering patient's position during examination may help detect anomalies in the form of a floating gallbladder, which may promote its torsion. Finally, pathologies whose diagnosis may be facilitated by color-coded blood flow imaging are also presented. The issues discussed in this paper are only a fraction of problems faced by an ultrasound operator in the field of gallbladder diagnostic imaging. However, the proposed ultrasound approaches should help solve some of these problems in everyday practice. Although transabdominal imaging of the gallbladder has become a gold standard, new light should be shed on some aspects, which will prove useful in everyday practice. Therefore, based on our own experience and the available literature, we would like to draw attention to those elements of gallbladder ultrasound imaging which may increase its diagnostic efficacy. The paper draws attention to the difficulty in assessing certain anatomical structures, such as the inferior wall, the bottom and the region of the neck of the gallbladder, and offers ways to improve their imaging. We also emphasized the negative effects of duodenal and transverse colon (along with their contents) adhesion to the bottom of the gallbladder on the correct diagnosis. Due to the importance of size in the management strategy for detected gallbladder polyps, we suggest their measurement on an image enlarged with the zoom function. This technique also allows for an accurate assessment of the shape and echostructure of these lesions. An enlarged image of a polyp makes it possible to trace its behavior in time. We also remind that the hepatic wall of the gallbladder is the only site allowing for a reliable wall thickness measurement. We also pointed to the importance of changing patient’s position when assessing the mobility and the nature of lesions. Altering patient’s position during examination may help detect anomalies in the form of a floating gallbladder, which may promote its torsion. Finally, pathologies whose diagnosis may be facilitated by color-coded blood flow imaging are also presented. The issues discussed in this paper are only a fraction of problems faced by an ultrasound operator in the field of gallbladder diagnostic imaging. However, the proposed ultrasound approaches should help solve some of these problems in everyday practice.
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Affiliation(s)
- Andrzej Smereczyński
- Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Bernatowicz
- Self-education Ultrasonographic Association, Department of Genetics and Pathomorphology, Pomeranian Medical University, Szczecin, Poland
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Lodhi A, Waite K, Alam I. The accuracy of ultrasonography for diagnosis of gallbladder polyps. Radiography (Lond) 2020; 26:e52-e55. [PMID: 32052774 DOI: 10.1016/j.radi.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gallbladder polyps (GBPs) are gallbladder lesions which can progress to gallbladder malignancy. The incidence has been estimated as high as 12.1% of all cholecystectomy patients. Gallbladder malignancy typically presents late, and therefore carries a poor prognosis. By identifying potential GBPs early, it would be possible to treat polyps before they undergo malignant change. The current gold standard for GBP identification is with histological examination which is performed after cholecystectomy. This study sought to assess whether radiological imaging could reliably identify GBPs and therefore guide management. METHODS 1000 consecutive patients already undergoing cholecystectomy were sampled from two UK hospitals. Patients who underwent ultrasonography and had histological analysis of their gallbladders were selected. Overall 905 patients were included in the study. RESULTS There were 12 histologically confirmed GBPs in the cohort (1.33%). US correctly detected 1 GBP, with a sensitivity of 8.3% (95% CI 0.2-38.5%) and specificity of 96.0% (95% CI 94.5-97.2%). The overall accuracy was 94.8 (95% CI 93.2-96.2%). CONCLUSION These data show that US is an ineffective tool for GBP identification. The lack of prior operator exposure, imprecise nature of US and possible obstruction of images from underlying gallstone disease delivered a high rate of false positives. IMPLICATIONS FOR PRACTICE Surgical or oncological decisions regarding GBPs should not be based upon US findings alone as this would lead to unnecessary interventions. MRI should be investigated as an alternative imaging modality for GBP identification, as its differentiation of soft tissues could guide surgical management.
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Affiliation(s)
- A Lodhi
- Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK.
| | - K Waite
- Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK
| | - I Alam
- Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK
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12
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Sun Y, Yang Z, Lan X, Tan H. Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps. Hepatobiliary Surg Nutr 2019; 8:219-227. [PMID: 31245402 DOI: 10.21037/hbsn.2018.12.15] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Preoperative differentiation of malignant and premalignant gallbladder polyps (GBPs) from benign lesions is a key imperative to guide treatment decision-making. We aimed to characterize the various types of GBPs and sought to identify the risk factors for neoplastic polyps. Our findings may help optimize treatment strategy. Methods Retrospective analysis of 686 patients with post-cholecystectomy pathologically-proven GBPs between January 2003 and December 2016. The patients were classified into non-neoplastic polyp group, benign neoplastic polyp group, and adenoma canceration group. Clinical features, ultrasound findings, and results of laboratory investigations and histopathological examination were reviewed and compared between the groups. Results Out of 686 patients, 542 (79.0%) had non-neoplastic polyps, 134 (19.5%) had neoplastic polyps, and 10 (1.5%) had adenoma canceration. The mean age was 46.06±12.12 years; 383 (55.8%) patients were female. The median (25th percentile, 75th percentile) time between diagnosis and surgery in the cholesterol polyp group [24 (3.5, 60) months] was significantly longer than that in adenoma [12 (2, 60) months] and adenoma canceration [5 (0.475, 12) months] groups. The mean diameter was 1.14±0.61 cm (range, 0.5-8.4 cm). Three hundred twelve (45.5%) patients had solitary polyps and intralesional blood flow was observed in 41 (6.0%) patients. On univariate analysis, age >49.5 years, polyp size >1.15 cm, solitary polyp, intralesional blood flow, absence of symptoms, and lack of cholecystitis showed a significant association with adenoma. On multivariate analysis, polyp size (>1.15 cm), intralesional blood flow, and lack of cholecystitis were independent predictors of adenoma. Conclusions Polyp size >1.15 cm, intralesional blood flow, and lack of cholecystitis were predictors of neoplastic polyps. Malignant transformation of adenoma may occur over a relatively short time.
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Affiliation(s)
- Yongliang Sun
- Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhiying Yang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xu Lan
- Department of Comprehensive Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Haidong Tan
- Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Patel K, Dajani K, Vickramarajah S, Huguet E. Five year experience of gallbladder polyp surveillance and cost effective analysis against new European consensus guidelines. HPB (Oxford) 2019; 21:636-642. [PMID: 30416065 DOI: 10.1016/j.hpb.2018.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/26/2018] [Accepted: 10/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder polyp (GBP) surveillance seeks to identify early neoplasms, but practice varies amongst surgical units. Recent European consensus guidelines have recommended an evidence-based GBP surveillance strategy. In a tertiary centre Hepato-Pancreato-Biliary unit we examine GBP surveillance, malignant yield, and assess cost-effectiveness of the new European consensus guidelines. METHODS Respective data were collected from all patients with ultrasonography-detected GBPs between January 2008 and January 2013. RESULTS 558 patients had GBPs detected on ultrasonography. Following initial ultrasonography, 304 (54.5%) had further ultrasonography surveillance of which 168 were in a formal GBP surveillance programme. Pre-malignant/malignant pathology yield was 1.97% with an annual detection rate of 12.0 cases per 1000 GBPs surveyed. Cost-effectiveness analysis of European consensus guidelines calculated annual savings of £209 163 per 1000 GBPs surveyed. Compliance with these guidelines would result in an additional 12.5% of patients under surveillance requiring cholecystectomy. CONCLUSION GBP surveillance uptake was suboptimal at 32.8%. The incidence of pre-malignant/malignant lesions in GBPs emphasises the importance of surveillance for early detection and management with a view to avoiding the poor outcomes associated with more advanced gallbladder cancer. Adherence to the new European consensus guidelines would be clinically cost-effective with significant potential savings demonstrated in this study.
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Affiliation(s)
- Krashna Patel
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Khaled Dajani
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Saranya Vickramarajah
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel Huguet
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Heitz L, Kratzer W, Gräter T, Schmidberger J. Gallbladder polyps - a follow-up study after 11 years. BMC Gastroenterol 2019; 19:42. [PMID: 30885181 PMCID: PMC6423886 DOI: 10.1186/s12876-019-0959-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/07/2019] [Indexed: 12/16/2022] Open
Abstract
Background The aim of our study was to investigate the prevalence and natural long-term progression of gallbladder polyps in a random sample of the general population. Methods Four hundred and thirteen subjects (190 women, 223 men; aged 29–75 years) were studied first in 2002 and again eleven years later in 2013. All subjects were interviewed using a standardised questionnaire, anthropometric data were recorded, and an abdominal ultrasound scan was carried out. Results The prevalence of gallbladder polyps was 6.1% (115/1880) in the 2002 study and 12.1% (50/413) in the 2013 follow-up study. After eleven years, 36 subjects (8.7%, 36/413) had developed new polyps, thirteen subjects (48.1%, 13/27) no longer had gallbladder polyps, and 14 subjects (51.9%, 14/27) still had polyps. The number of polyps had increased in six of these subjects (43%, 6/14), decreased in a further six (43%, 6/14), and remained unchanged in two (14%, 2/14). The mean polyp size was 4.7 mm (± 2.2 mm, range 2–20 mm) in 2002 and 4.0 mm (± 1.9 mm, range 0.5–11 mm) at follow-up. A decrease in polyp size was noted in seven (50%) of the 14 subjects, an increase in size in five subjects (35.7%), and no change in two subjects (14.3%). The shape of the polyps had changed from pedunculated to sessile in two subjects (14.3%, 2/14) and from sessile to pedunculated in one subject (7.1%, 1/14). Conclusions In long-term follow-up, the prevalence of gallbladder polyps increased, with new lesions developing in 8.7% of the population. Polyps persisted in 51.9% of the subjects who had them in the original study and disappeared in the other 48.1%.
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Affiliation(s)
- Linda Heitz
- Centre for Internal Medicine, Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Centre for Internal Medicine, Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Tilmann Gräter
- Department of Diagnostic and Interventional Radiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Julian Schmidberger
- Centre for Internal Medicine, Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps. Surg Endosc 2018; 33:1564-1571. [PMID: 30203209 PMCID: PMC6484812 DOI: 10.1007/s00464-018-6444-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
Background A significant proportion of gallbladder polyps are non-neoplastic, for which resection is not necessary. However, international guidelines advocate cholecystectomy for all polyps ≥ 1 cm. This study assessed a national cohort of histopathologically proven gallbladder polyps to distinguish neoplastic from non-neoplastic polyps. Methods PALGA, the nationwide network and registry of histo- and cytopathology, was searched to identify all histopathologically proven gallbladder polyps between 2003 and 2013. All polyps and (focal) wall thickenings > 5 mm were included, and classified as neoplastic or non-neoplastic. Polyp subtype, size, distribution, presentation as wall thickening or protruding polyp, and presence of gallstones were assessed for neoplastic and non-neoplastic polyps. A decision tree to distinguish neoplastic and non-neoplastic polyps was made and diagnostic accuracy of 1 cm surgical threshold was calculated. Results A total of 2085 out of 220,612 cholecystectomies contained a polyp (0.9%). Of these polyps, 56.4% were neoplastic (40.1% premalignant, 59.9% malignant) and 43.6% non-neoplastic (41.5% cholesterol polyp, 37.0% adenomyomatosis, 21.5% other). Polyp size, distribution, and presence of gallstones were reported in 1059, 1739 and 1143 pathology reports, respectively. Neoplastic polyps differed from non-neoplastic polyps in size (18.1 mm vs 7.5 mm, p < 0.001), singularity (88.2% vs 68.2%, p < 0.001), wall thickening (29.1% vs 15.6%, p < 0.001), and presence of gallstones (50.1% vs 40.4%, p = 0.001). However, adenomyomatosis presented with similar characteristics as neoplastic polyps. Fifty percent of polyps were ≥ 1 cm surgical threshold (optimal surgical threshold based on ROC-curve); sensitivity for indicating neoplastic polyps was 68.1%, specificity was 70.2%, and positive and negative predictive values were 72.9% and 65.1%. Conclusions The prevalence of gallbladder polyps on cholecystectomy is low and many of the polyps are non-neoplastic. Clinicopathological characteristics differ between neoplastic and non-neoplastic polyps in general, but these cannot properly indicate neoplasia. The 1 cm surgical threshold has moderate diagnostic accuracy and is insufficient to indicate surgery for neoplastic gallbladder polyps.
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Wennmacker SZ, Lamberts MP, Di Martino M, Drenth JPH, Gurusamy KS, van Laarhoven CJHM, Cochrane Hepato‐Biliary Group. Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps. Cochrane Database Syst Rev 2018; 8:CD012233. [PMID: 30109701 PMCID: PMC6513652 DOI: 10.1002/14651858.cd012233.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Approximately 0.6% to 4% of cholecystectomies are performed because of gallbladder polyps. The decision to perform cholecystectomy is based on presence of gallbladder polyp(s) on transabdominal ultrasound (TAUS) or endoscopic ultrasound (EUS), or both. These polyps are currently considered for surgery if they grow more than 1 cm. However, non-neoplastic polyps (pseudo polyps) do not need surgery, even when they are larger than 1 cm. True polyps are neoplastic, either benign (adenomas) or (pre)malignant (dysplastic polyps/carcinomas). True polyps need surgery, especially if they are premalignant or malignant. There has been no systematic review and meta-analysis on the accuracy of TAUS and EUS in the diagnosis of gallbladder polyps, true gallbladder polyps, and (pre)malignant polyps. OBJECTIVES To summarise and compare the accuracy of transabdominal ultrasound (TAUS) and endoscopic ultrasound (EUS) for the detection of gallbladder polyps, for differentiating between true and pseudo gallbladder polyps, and for differentiating between dysplastic polyps/carcinomas and adenomas/pseudo polyps of the gallbladder in adults. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded, and trial registrations (last date of search 09 July 2018). We had no restrictions regarding language, publication status, or prospective or retrospective nature of the studies. SELECTION CRITERIA Studies reporting on the diagnostic accuracy data (true positive, false positive, false negative and true negative) of the index test (TAUS or EUS or both) for detection of gallbladder polyps, differentiation between true and pseudo polyps, or differentiation between dysplastic polyps/carcinomas and adenomas/pseudo polyps. We only accepted histopathology after cholecystectomy as the reference standard, except for studies on diagnosis of gallbladder polyp. For the latter studies, we also accepted repeated imaging up to six months by TAUS or EUS as the reference standard. DATA COLLECTION AND ANALYSIS Two authors independently screened abstracts, selected studies for inclusion, and collected data from each study. The quality of the studies was evaluated using the QUADAS-2 tool. The bivariate random-effects model was used to obtain summary estimates of sensitivity and specificity, to compare diagnostic performance of the index tests, and to assess heterogeneity. MAIN RESULTS A total of 16 studies were included. All studies reported on TAUS and EUS as separate tests and not as a combination of tests. All studies were at high or unclear risk of bias, ten studies had high applicability concerns in participant selection (because of inappropriate participant exclusions) or reference standards (because of lack of follow-up for non-operated polyps), and three studies had unclear applicability concerns in participant selection (because of high prevalence of gallbladder polyps) or index tests (because of lack of details on ultrasound equipment and performance). A meta-analysis directly comparing results of TAUS and EUS in the same population could not be performed because only limited studies executed both tests in the same participants. Therefore, the results below were obtained only from indirect test comparisons. There was significant heterogeneity amongst all comparisons (target conditions) on TAUS and amongst studies on EUS for differentiating true and pseudo polyps.Detection of gallbladder polyps: Six studies (16,260 participants) used TAUS. We found no studies on EUS. The summary sensitivity and specificity of TAUS for the detection of gallbladder polyps was 0.84 (95% CI 0.59 to 0.95) and 0.96 (95% CI 0.92 to 0.98), respectively. In a cohort of 1000 people, with a 6.4% prevalence of gallbladder polyps, this would result in 37 overdiagnosed and seven missed gallbladder polyps.Differentiation between true polyp and pseudo gallbladder polyp: Six studies (1078 participants) used TAUS; the summary sensitivity was 0.68 (95% CI 0.44 to 0.85) and the summary specificity was 0.79 (95% CI 0.57 to 0.91). Three studies (209 participants) used EUS; the summary sensitivity was 0.85 (95% CI 0.46 to 0.97) and the summary specificity was 0.90 (95% CI 0.78 to 0.96). In a cohort of 1000 participants with gallbladder polyps, with 10% having true polyps, this would result in 189 overdiagnosed and 32 missed true polyps by TAUS, and 90 overdiagnosed and 15 missed true polyps by EUS. There was no evidence of a difference between the diagnostic accuracy of TAUS and EUS (relative sensitivity 1.06, P = 0.70, relative specificity 1.15, P = 0.12).Differentiation between dysplastic polyps/carcinomas and adenomas/pseudo polyps of the gallbladder: Four studies (1,009 participants) used TAUS; the summary sensitivity was 0.79 (95% CI 0.62 to 0.90) and the summary specificity was 0.89 (95% CI 0.68 to 0.97). Three studies (351 participants) used EUS; the summary sensitivity was 0.86 (95% CI 0.76 to 0.92) and the summary specificity was 0.92 (95% CI 0.85 to 0.95). In a cohort of 1000 participants with gallbladder polyps, with 5% having a dysplastic polyp/carcinoma, this would result in 105 overdiagnosed and 11 missed dysplastic polyps/carcinomas by TAUS and 76 overdiagnosed and seven missed dysplastic polyps/carcinomas by EUS. There was no evidence of a difference between the diagnostic accuracy of TAUS and EUS (log likelihood test P = 0.74). AUTHORS' CONCLUSIONS Although TAUS seems quite good at discriminating between gallbladder polyps and no polyps, it is less accurate in detecting whether the polyp is a true or pseudo polyp and dysplastic polyp/carcinoma or adenoma/pseudo polyp. In practice, this would lead to both unnecessary surgeries for pseudo polyps and missed cases of true polyps, dysplastic polyps, and carcinomas. There was insufficient evidence that EUS is better compared to TAUS in differentiating between true and pseudo polyps and between dysplastic polyps/carcinomas and adenomas/pseudo polyps. The conclusions are based on heterogeneous studies with unclear criteria for diagnosis of the target conditions and studies at high or unclear risk of bias. Therefore, results should be interpreted with caution. Further studies of high methodological quality, with clearly stated criteria for diagnosis of gallbladder polyps, true polyps, and dysplastic polyps/carcinomas are needed to accurately determine diagnostic accuracy of EUS and TAUS.
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Affiliation(s)
- Sarah Z Wennmacker
- Radboud University Medical Center NijmegenDepartment of SurgeryPO Box 9101internal code 618NijmegenNetherlands6500 HB
| | - Mark P Lamberts
- Radboud University Medical Center NijmegenDepartment of Gastroenterology and HepatologyP.O. Box 9101, code 455NijmegenNetherlands
| | | | - Joost PH Drenth
- Radboud University Medical Center NijmegenDepartment of Gastroenterology and HepatologyP.O. Box 9101, code 455NijmegenNetherlands
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Cornelis JHM van Laarhoven
- Radboud University Medical Center NijmegenDepartment of SurgeryPO Box 9101internal code 618NijmegenNetherlands6500 HB
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McCain RS, Diamond A, Jones C, Coleman HG. Current practices and future prospects for the management of gallbladder polyps: A topical review. World J Gastroenterol 2018; 24:2844-2852. [PMID: 30018479 PMCID: PMC6048427 DOI: 10.3748/wjg.v24.i26.2844] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/23/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023] Open
Abstract
A gallbladder polyp is an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen. Gallbladder polyps have an estimated prevalence in adults of between 0.3%-12.3%. However, only 5% of polyps are considered to be "true" gallbladder polyps, meaning that they are malignant or have malignant potential. The main radiological modality used for diagnosing and surveilling gallbladder polyps is transabdominal ultrasonography. However, evidence shows that other modalities such as endoscopic ultrasound may improve diagnostic accuracy. These are discussed in turn during the course of this review. Current guidelines recommend cholecystectomy for gallbladder polyps sized 10 mm and greater, although this threshold is lowered when other risk factors are identified. The evidence behind this practice is relatively low quality. This review identifies current gaps in the available evidence and highlights the necessity for further research to enable better decision making regarding which patients should undergo cholecystectomy, and/or radiological follow-up.
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Affiliation(s)
- R Stephen McCain
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast BT12 6BJ, United Kingdom
| | - Anna Diamond
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast BT16 1RH, United Kingdom
| | - Claire Jones
- Mater Hospital, Belfast Health and Social Care Trust, Queens University Belfast, Belfast BT12 6BJ, United Kingdom
| | - Helen G Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BJ, United Kingdom
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18
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Liu XS, Chen T, Gu LH, Guo YF, Li CY, Li FH, Wang J. Ultrasound-based scoring system for differential diagnosis of polypoid lesions of the gallbladder. J Gastroenterol Hepatol 2018; 33:1295-1299. [PMID: 29280187 DOI: 10.1111/jgh.14080] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Polypoid lesions of the gallbladder may be neoplastic or non-neoplastic. Correct diagnosis would help reduce unnecessary cholecystectomies. This study aimed to determine the predictive value of individual ultrasound characteristics for diagnosis of neoplastic polyps and to build a scoring system based on these characteristics. METHODS A total of 109 patients with gallbladder polyps ≥ 6 mm underwent conventional ultrasound examination and received finally diagnosis by pathological examination. All images were analyzed to determine characteristics of the lesions. Univariate and multivariate analyses were used to identify the predictors of neoplastic polyps, and a scoring system was built based on multivariate analysis. RESULTS Maximum diameter, height/width ratio, base width, presence of hyper-echoic spots, and intralesional blood flow were statistically significant (P = 0.011, P = 0.016, P = 0.003, P = 0.031, and P = 0.022, respectively) predictors of neoplastic lesions. The total score = (Maximum diameter, ≥ 13.9 mm = 1, < 13.9 = 0) + (Base width, ≥ 3.5 mm = 1, < 3.4 = 0) + (Height/width ratio, ≤ 1.05 = 1, > 1.05 = 0) + (Hyper-echoic spots, presence = 0, absence = 1) + (Blood flow, presence = 1, absence = 0). Receiver operating characteristic curve showed that the sensitivity, specificity, and accuracy for the risk of neoplastic polyps with scores of 3 or higher were 81.6%, 86.7%, and 84.4%, respectively. CONCLUSION This ultrasound-based scoring system could be a useful means for differentiating between neoplastic and non-neoplastic gallbladder polyps in the clinic.
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Affiliation(s)
- Xue-Song Liu
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Chen
- Department of Biliary and Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Li-Hong Gu
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yi-Fen Guo
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chun-Yang Li
- Department of Biliary and Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Feng-Hua Li
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jian Wang
- Department of Biliary and Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg 2018; 61:200-207. [PMID: 29806818 PMCID: PMC5973908 DOI: 10.1503/cjs.011617] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous research has shown variable but generally poor accuracy of transabdominal ultrasonography in the diagnosis of gallbladder polyps. We performed a systematic review of the literature with the aim of helping surgeons interpret and apply these findings in the preoperative assessment and counselling of their patients. METHODS We searched PubMed, MEDLINE and the Cochrane database using the keywords "gallbladder," "polyp," "ultrasound," "pathology" and "diagnosis" for English-language articles published after 1990 with the full-text article available through our institutional subscriptions. Polyps were defined as immobile features that on transabdominal ultrasonography appear to arise from the mucosa and that lack an acoustic shadow, and pseudopolyps were defined as features such as inflammation, hyperplasia, cholesterolosis and adenomyomatosis that convey no risk of malignant transformation. RESULTS The search returned 1816 articles, which were narrowed down to 14 primary sources involving 15 497 (range 23-13 703) patients who had preoperative transabdominal ultrasonography, underwent cholecystectomy and had postoperative pathology results available. Among the 1259 patients in whom a gallbladder polyp was diagnosed on ultrasonography, 188 polyps were confirmed as true polyps on pathologic examination, and 81 of these were found to be malignant. Of the 14 238 patients for whom a polyp was not seen on ultrasonography, 38 had a true polyp on pathologic examination, none of which were malignant. For true gallbladder polyps, transabdominal ultrasonography had a sensitivity of 83.1%, specificity of 96.3%, positive predictive value of 14.9% (7.0% for malignant polyps) and negative predictive value of 99.7%. CONCLUSION Transabdominal ultrasonography has a high false-positive rate (85.1%) for the diagnosis of gallbladder polyps. Further study of alternative imaging modalities and reevaluation of existing management guidelines are warranted.
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Affiliation(s)
- Erin Martin
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - Richdeep Gill
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - Estifanos Debru
- From the Department of Surgery, University of Calgary, Calgary, Alta
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Kim SY, Cho JH, Kim EJ, Chung DH, Kim KK, Park YH, Kim YS. The efficacy of real-time colour Doppler flow imaging on endoscopic ultrasonography for differential diagnosis between neoplastic and non-neoplastic gallbladder polyps. Eur Radiol 2017; 28:1994-2002. [PMID: 29218621 DOI: 10.1007/s00330-017-5175-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/23/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We evaluated the usefulness of real-time colour Doppler flow (CDF) endoscopic ultrasonography (EUS) for differentiating neoplastic gallbladder (GB) polyps from non-neoplastic polyps. METHODS Between August 2014 and December 2016, a total of 233 patients with GB polyps who underwent real-time CDF-EUS were consecutively enrolled in this prospective study. CDF imaging was subjectively categorized for each patient as: strong CDF pattern, weak CDF pattern and no CDF pattern. RESULTS Of the 233 patients, 115 underwent surgical resection. Of these, there were 90 cases of non-neoplastic GB polyps and 23 cases of neoplastic GB polyps. In a multivariate analysis, a strong CDF pattern was the most significant predictive factor for neoplastic polyps; sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 52.2 %, 79.4 %, 38.7 %, 86.9 % and 73.9 %, respectively. Solitary polyp and polyp size were associated with an increased risk of neoplasm. CONCLUSIONS The presence of a strong CDF pattern as well as solitary and larger polyps on EUS may be predictive of neoplastic GB polyps. As real-time CDF-EUS poses no danger to the patient and requires no additional equipment, it is likely to become a supplemental tool for the differential diagnosis of GB polyps. KEY POINTS • Differential diagnosis between neoplastic polyps and non-neoplastic polyps of GB is limited. • The use of real-time CDF-EUS was convenient, with high agreement between operators. • The real-time CDF-EUS is helpful in differential diagnosis of GB polyps.
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Affiliation(s)
- Su Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea.
| | - Eui Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
| | - Dong Hae Chung
- Department of Pathology, Gachon University, Gil Medical Center, Incheon, Republic of Korea
| | - Kun Kuk Kim
- Department of Surgery, Gachon University, Gil Medical Center, Incheon, Republic of Korea
| | - Yeon Ho Park
- Department of Surgery, Gachon University, Gil Medical Center, Incheon, Republic of Korea
| | - Yeon Suk Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea
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Sarici IS, Duzgun O. Gallbladder polypoid lesions >15mm as indicators of T1b gallbladder cancer risk. Arab J Gastroenterol 2017; 18:156-158. [PMID: 28958638 DOI: 10.1016/j.ajg.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/16/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Gallbladder polyps (GBPs) are found in 5-7% of the adult population. However, it is very important to differentiate between benign and malignant polyps to establish an appropriate treatment. The present study aimed to determine the relevance of the 10-mm size criterion and attempted to determine the cut-off diameter of T1b tumours, which requires additional surgical intervention. PATIENTS AND METHODS Cases with GBPs were collected between January 2005 and January 2015. A total of 109 patients were enroled retrospectively. Information on age, sex, ultrasound findings, and blood laboratory tests was reviewed. The 10-mm criterion and T1b tumours were examined. RESULTS Sixty-nine females and 40 males were included in the study. Patient age was 45±10.7years (range 27-70years). The 10-mm cut-off sensitivity and specificity for predicting malignant polyps was 93.6% and 85.2%, respectively. Fifteen patients had malignant pathologic results, and one patient had GBP <10mm (intraepithelial, 8mm). Two patients had intraepithelial tumours of 12 and 13mm. Twelve malignant patients had T1b tumours with polyp sizes >15mm. CONCLUSION Gallbladder cancer may occur in polyps of <10mm. Larger size and older age were predictors of neoplastic GBPs. We suggest 15mm as the optimal cut-off point to predict T1b cancer.
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Affiliation(s)
- Inanc Samil Sarici
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Ozgul Duzgun
- Department of Surgical Oncology, Cukurova University, Adana, Turkey
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Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, Sleiman Z, Campo R, Gordts S. The management of polyps in female reproductive organs. Int J Surg 2017; 43:7-16. [DOI: 10.1016/j.ijsu.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Wiles R, Thoeni RF, Barbu ST, Vashist YK, Rafaelsen SR, Dewhurst C, Arvanitakis M, Lahaye M, Soltes M, Perinel J, Roberts SA. Management and follow-up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 2017; 27:3856-3866. [PMID: 28185005 PMCID: PMC5544788 DOI: 10.1007/s00330-017-4742-y] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Objectives The management of incidentally detected gallbladder polyps on radiological examinations is contentious. The incidental radiological finding of a gallbladder polyp can therefore be problematic for the radiologist and the clinician who referred the patient for the radiological examination. To address this a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Methods A targeted literature search was performed and consensus guidelines were created using a series of Delphi questionnaires and a seven-point Likert scale. Results A total of three Delphi rounds were performed. Consensus regarding which patients should have cholecystectomy, which patients should have ultrasound follow-up and the nature and duration of that follow-up was established. The full recommendations as well as a summary algorithm are provided. Conclusions These expert consensus recommendations can be used as guidance when a gallbladder polyp is encountered in clinical practice. Key Points • Management of gallbladder polyps is contentious • Cholecystectomy is recommended for gallbladder polyps >10 mm • Management of polyps <10 mm depends on patient and polyp characteristics • Further research is required to determine optimal management of gallbladder polyps
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Affiliation(s)
- Rebecca Wiles
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L78XP, UK.
| | - Ruedi F Thoeni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical School, San Francisco, CA, USA
| | - Sorin Traian Barbu
- 4th Surgery Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Yogesh K Vashist
- Section for Visceral Surgery, Department of Surgery, Kantonsspital Aarau, Aarau, Switzerland.,Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Søren Rafael Rafaelsen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, University of Southern Denmark, Odense M, Denmark
| | - Catherine Dewhurst
- Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital ULB, Brussels, Belgium
| | - Max Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marek Soltes
- 1st Department of Surgery LF UPJS a UNLP, Kosice, Slovakia
| | - Julie Perinel
- Department of Hepatobiliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France
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Wennmacker SZ, Lamberts MP, Drenth JPH, Gurusamy KS, van Laarhoven CJHM. Transabdominal ultrasound or endoscopic ultrasound for diagnosis of gallbladder polyps. Hippokratia 2016. [DOI: 10.1002/14651858.cd012233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Z Wennmacker
- Radboud University Medical Center Nijmegen; Department of Surgery; PO Box 9101 internal code 618 Nijmegen Netherlands 6500 HB
| | - Mark P Lamberts
- Radboud University Medical Center Nijmegen; Department of Gastroenterology and Hepatology; P.O. Box 9101, code 455 Nijmegen Netherlands
| | - Joost PH Drenth
- Radboud University Medical Center Nijmegen; Department of Gastroenterology and Hepatology; P.O. Box 9101, code 455 Nijmegen Netherlands
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical School; Department of Surgery; Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Cornelis JHM van Laarhoven
- Radboud University Medical Center Nijmegen; Department of Surgery; PO Box 9101 internal code 618 Nijmegen Netherlands 6500 HB
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Aliyazicioglu T, Carilli S, Emre A, Kaya A, Bugra D, Bilge O, Yalti T, Kabaoglu B, Alper A. Contribution of gallbladder polyp surgery to treatment. Eur Surg 2016. [DOI: 10.1007/s10353-016-0422-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mellnick VM, Menias CO, Sandrasegaran K, Hara AK, Kielar AZ, Brunt EM, Doyle MBM, Dahiya N, Elsayes KM. Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics 2016; 35:387-99. [PMID: 25763724 DOI: 10.1148/rg.352140095] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gallbladder polyps are seen on as many as 7% of gallbladder ultrasonographic images. The differential diagnosis for a polypoid gallbladder mass is wide and includes pseudotumors, as well as benign and malignant tumors. Tumefactive sludge may be mistaken for a gallbladder polyp. Pseudotumors include cholesterol polyps, adenomyomatosis, and inflammatory polyps, and they occur in that order of frequency. The most common benign and malignant tumors are adenomas and primary adenocarcinoma, respectively. Polyp size, shape, and other ancillary imaging findings, such as a wide base, wall thickening, and coexistent gallstones, are pertinent items to report when gallbladder polyps are discovered. These findings, as well as patient age and risk factors for gallbladder cancer, guide clinical decision making. Symptomatic polyps without other cause for symptoms, an age over 50 years, and the presence of gallstones are generally considered indications for cholecystectomy. Incidentally noted pedunculated polyps smaller than 5 mm generally do not require follow-up. Polyps that are 6-10 mm require follow-up, although neither the frequency nor the length of follow-up has been established. Polyps that are larger than 10 mm are typically excised, although lower size thresholds for cholecystectomy may be considered for patients with increased risk for gallbladder carcinoma, such as patients with primary sclerosing cholangitis.
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Affiliation(s)
- Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (V.M.M.), Department of Pathology (E.M.B.), and Department of Surgery (M.B.M.D.),Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H., N.D.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (A.Z.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Bhatt NR, Gillis A, Smoothey CO, Awan FN, Ridgway PF. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon 2016; 14:278-86. [PMID: 26825588 DOI: 10.1016/j.surge.2015.12.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected. AIM To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management. METHODS A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy. RESULTS Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm-10 mm, a risk assessment model was formulated. CONCLUSIONS This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time.
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Affiliation(s)
- Nikita R Bhatt
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Amy Gillis
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Craig O Smoothey
- School of Mechanical and Materials Engineering, University College Dublin, Ireland
| | - Faisal N Awan
- Department of Hepatobiliary Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
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Goetze TO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol 2015; 21:12211-12217. [PMID: 26604631 PMCID: PMC4649107 DOI: 10.3748/wjg.v21.i43.12211] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/20/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open
Abstract
The outcome of gallbladder carcinoma is poor, and the overall 5-year survival rate is less than 5%. In early-stage disease, a 5-year survival rate up to 75% can be achieved if stage-adjusted therapy is performed. There is wide geographic variability in the frequency of gallbladder carcinoma, which can only be explained by an interaction between genetic factors and their alteration. Gallstones and chronic cholecystitis are important risk factors in the formation of gallbladder malignancies. Factors such as chronic bacterial infection, primary sclerosing cholangitis, an anomalous junction of the pancreaticobiliary duct, and several types of gallbladder polyps are associated with a higher risk of gallbladder cancer. There is also an interesting correlation between risk factors and the histological type of cancer. However, despite theoretical risk factors, only a third of gallbladder carcinomas are recognized preoperatively. In most patients, the tumor is diagnosed by the pathologist after a routine cholecystectomy for a benign disease and is termed ‘‘incidental or occult gallbladder carcinoma’’ (IGBC). A cholecystectomy is performed frequently due to the minimal invasiveness of the laparoscopic technique. Therefore, the postoperative diagnosis of potentially curable early-stage disease is more frequent. A second radical re-resection to complete a radical cholecystectomy is required for several IGBCs. However, the literature and guidelines used in different countries differ regarding the radicality or T-stage criteria for performing a radical cholecystectomy. The NCCN guidelines and data from the German registry (GR), which records the largest number of incidental gallbladder carcinomas in Europe, indicate that carcinomas infiltrating the muscularis propria or beyond require radical surgery. According to GR data and current literature, a wedge resection with a combined dissection of the lymph nodes of the hepatoduodenal ligament is adequate for T1b and T2 carcinomas. The reason for a radical cholecystectomy after simple CE in a formally R0 situation is either occult invasion or hepatic spread with unknown lymphogenic dissemination. Unfortunately, there are diverse interpretations and practices regarding stage-adjusted therapy for gallbladder carcinoma. The current data suggest that more radical therapy is warranted.
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Lu D, Radin R, Yung E, Tchelepi H. Malignant transformation of a 5-mm gallbladder polyp over 2 years: a case report and review of current literature. Ultrasound Q 2015; 31:66-8. [PMID: 25054905 DOI: 10.1097/ruq.0000000000000094] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gallbladder polyps (GBPs) are incidentally seen in 4% to 7% of adults on abdominal ultrasounds. Most GBPs are benign cholesterol polyps, adenomyomatosis, or inflammatory polyps. Currently, cholecystectomy is widely accepted as appropriate care for polyps 10 mm or larger as they present a higher risk for malignancy. However, the management of small polyps smaller than 10 mm has continued to be a dilemma to clinicians and radiologists. Many authors support a nonoperative approach with imaging follow-up for polyps smaller than 10 mm, as most have been shown to be benign. However, small polyps do have the potential to be neoplastic adenomas and become malignant. In this report, we will describe a case of a tiny GBP that subsequently developed into a 20-mm carcinoma over a period of 2 years.
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Affiliation(s)
- Darren Lu
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA
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Guo J, Wu G, Zhou Z. Polypoid lesions of the gallbladder: report of 160 cases with special reference to diagnosis and treatment in China. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:11569-11578. [PMID: 26617893 PMCID: PMC4637709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/23/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The preoperative diagnosis of gallbladder polypoid lesions is difficult, justifying the lack of consensus on the appropriate treatment. OBJECTIVE The aim of this study was to identify the characteristics of each type of polypoid lesion of the gallbladder and the indications for surgery. METHODS Between January 1999 and December 2012, clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions in 160 patients who underwent cholecystectomy. RESULTS A total of 160 patients with benign polypoid lesions (including 49 tumor-like lesions and 75 adenomas) and 14 patients with malignant polypoid lesions (including 2 adenocarcinomas and 12 adenomas with malignant changes) were included in this study. One hundred and five (65.6%) of the patients had associated symptoms, and 70 (43.8%) had gallstones. Of the 49 patients with tumor-like lesions, 49 (100%) were correlated with chronic cholecystitis. A total of 72 (83.8%) patients with neoplasms had a single polyp compared with 25 (59.5%) of those with non-neoplastic polyps. The mean age of the patients with malignancy was 59.07 ± 13.465 years, and 12 (85.7%) of these patients were over 50 years of age. The mean diameters of the benign and malignant polyps were 1.0 ± 0.77 cm and 2.15 ± 1.16 cm, respectively. Ten (100%) of the patients with malignancy had polyps of over 1 cm in size, as shown by ultrasound. CONCLUSION Our findings indicate that tumor-like lesions, adenomas, and adenocarcinomas are the most common polypoid lesions of the gallbladder. Cholecystecomy should be done in patients with symptoms. The risk of malignancy is high in patients over 50 years of age; those with polyps with diameters of greater than 10 mm; and those with single polypoid lesions. The remainder of PLG patients without cholecystectomy should be followed up at regular intervals.
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Affiliation(s)
- Jingjing Guo
- Department of General Surgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Gang Wu
- Department of General Surgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Zhongwen Zhou
- Department of Pathology, Huashan Hospital, Fudan UniversityShanghai 200040, China
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Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, Coimbra FJF, Jarnagin WR. Gallbladder cancer: expert consensus statement. HPB (Oxford) 2015; 17:681-90. [PMID: 26172135 PMCID: PMC4527853 DOI: 10.1111/hpb.12444] [Citation(s) in RCA: 316] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled. Provided the patient is medically fit for surgery, data support the resection of all gallbladder polyps of >1.0 cm in diameter and those with imaging evidence of vascular stalks. The minimum staging evaluation of patients with suspected or proven gallbladder cancer includes contrasted cross-sectional imaging and diagnostic laparoscopy. Adequate lymphadenectomy includes assessment of any suspicious regional nodes, evaluation of the aortocaval nodal basin, and a goal recovery of at least six nodes. Patients with confirmed metastases to N2 nodal stations do not benefit from radical resection and should receive systemic and/or palliative treatments. Primary resection of patients with early T-stage (T1b-2) disease should include en bloc resection of adjacent liver parenchyma. Patients with T1b, T2 or T3 disease that is incidentally identified in a cholecystectomy specimen should undergo re-resection unless this is contraindicated by advanced disease or poor performance status. Re-resection should include complete portal lymphadenectomy and bile duct resection only when needed to achieve a negative margin (R0) resection. Patients with preoperatively staged T3 or T4 N1 disease should be considered for clinical trials of neoadjuvant chemotherapy. Following R0 resection of T2-4 disease in N1 gallbladder cancer, patients should be considered for adjuvant systemic chemotherapy and/or chemoradiotherapy.
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Affiliation(s)
- Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA,Correspondence Thomas A. Aloia, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030, USA. Tel: + 1 713 563 0189. Fax: + 1 713 745 1921. E-mail:
| | - Nicolas Járufe
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Católica de Chile)Santiago, Chile
| | - Milind Javle
- Department of GI Medical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Juan C Roa
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Catolica de Chile)Santiago, Chile
| | - Volkan Adsay
- Department of Pathology and Laboratory Medicine, Winship Cancer InstituteEmory University, Atlanta, GA, USA
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer CentreSão Paulo, Brazil
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
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Kasle D, Rahnemai-Azar AA, Bibi S, Gaduputi V, Gilchrist BF, Farkas DT. Carcinoma in situ in a 7 mm gallbladder polyp: Time to change current practice? World J Gastrointest Endosc 2015; 7:912-915. [PMID: 26240692 PMCID: PMC4515425 DOI: 10.4253/wjge.v7.i9.912] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/27/2015] [Accepted: 05/27/2015] [Indexed: 02/05/2023] Open
Abstract
Detection of polypoid lesions of the gallbladder is increasing in conjunction with better imaging modalities. Accepted management of these lesions depends on their size and symptomatology. Polyps that are symptomatic and/or greater than 10 mm are generally removed, while smaller, asymptomatic polyps simply monitored. Here, a case of carcinoma-in-situ is presented in a 7 mm gallbladder polyp. A 25-year-old woman, who had undergone a routine cholecystectomy, was found to have an incidental 7 mm polyp containing carcinoma in situ. She had few to no risk factors to alert to her condition. There are few reported cases of cancer transformation in gallbladder polyps smaller than 10 mm reported in the literature. The overwhelming consensus, barring significant risk factors for cancer being present, is that such lesions should be monitored until they become symptomatic or develop signs suspicious for malignancy. In our patient’s case this could have led to the possibility of missing a neoplastic lesion, which could then have gone on to develop invasive cancer. As gallbladder carcinoma is an aggressive cancer, this may have led to a tragic outcome.
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Kim JS, Lee JK, Kim Y, Lee SM. US characteristics for the prediction of neoplasm in gallbladder polyps 10 mm or larger. Eur Radiol 2015; 26:1134-40. [PMID: 26188659 DOI: 10.1007/s00330-015-3910-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/14/2015] [Accepted: 06/29/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the characteristics of gallbladder polyps 10 mm or larger to predict a neoplasm in US examinations. MATERIALS AND METHODS Fifty-three patients with gallbladder polyps ≥ 10 mm with follow-up images or pathologic diagnosis were included in the retrospective study. All images and reports were reviewed to determine the imaging characteristics of gallbladder polyps. Univariate and multivariate analyses were used to evaluate predictors for a neoplastic polyp. RESULTS A neoplastic polyp was verified in 12 of 53 patients and the mean size was 13.9 mm. The univariate analysis revealed that adjacent gallbladder wall thickening, larger size (≥15 mm), older age (≥57 years), absence of hyperechoic foci in a polyp, CT visibility, sessile shape, a solitary polyp, and an irregular surface were significant predictors for a neoplastic polyp. In the multivariate analysis, larger size (≥15 mm) was a significant predictor for a neoplastic polyp. CONCLUSION A polyp size ≥15 mm was the strongest predictor for a neoplastic polyp with US. The hyperechoic foci in a polyp and CT visibility would be useful indicators for the differentiation of a neoplastic polyp, in addition to the established predictors. KEY POINTS • A polyp size ≥15 mm is the strongest predictor for a neoplastic polyp with US. • Hyperechoic foci in a polyp and CT visibility are new predictors. • The rate of malignancy is low in polyps even 10 mm or larger (15.1 %).
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Affiliation(s)
- Jin Sil Kim
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Jeong Kyong Lee
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea.
| | - Yookyung Kim
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea
| | - Sang Min Lee
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea
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Wang J, Tan Y, Zhao G, Wang D, Ji Z. A new exploration for gallbladder polyps: gallbladder polypectomy by endolap technique. J Laparoendosc Adv Surg Tech A 2015; 24:852-7. [PMID: 25387240 DOI: 10.1089/lap.2014.0418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract Gallbladder polyps are most commonly treated with cholecystectomy, which is associated with various complications. For benign disease, preserving the gallbladder is preferable. Since 1994, we have been exploring percutaneous polypectomy and have recently developed an improved new technique. This study reports a new endoscopic-laparoscopic (Endolap) technique for the removal of polyps and the preservation of the gallbladder. Nine Chinese mini-pigs were used to observe mucosal regeneration. Microwaves of 50-70 mA for 9 seconds were safe, and the gallbladder mucosa of pigs recovered to nearly normal 2 weeks later. In the clinical cases, 60 patients with gallbladder polyps were studied. With the patient under general anesthesia, each polyp stem was coagulated, and then the polyp was removed. All procedures were successful at between 60 and 135 minutes. The success rate was 93.33% (56/60). A retrospective analysis was conducted to assess the recovery of gallbladder function. All patients were followed up and symptom-free, without recurrence of the polyps; 3 months after the operation, the volume and contraction of the gallbladder recovered to preoperative levels. Thus the Endolap technique is reliable for removing benign gallbladder polyps and is applicable to a wider range of clinical situations than percutaneous polypectomy.
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Affiliation(s)
- JingMin Wang
- Department of General Surgery, Institute for Minimally Invasive Surgery, Zhongda Hospital Southeast University, Medical School of Southeast University , Nanjing, Jiangsu, China
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Heger E, Lammert F. [Biliary diseases in the elderly]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2014; 52:447-9. [PMID: 24824910 DOI: 10.1055/s-0034-1366158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gallstone disease is more common in the elderly. In this short review, we summarize guideline-based recommendations for the diagnosis and treatment of biliary diseases in elderly patients. Warning episodes of biliary colic represent a general indication for cholecystectomy to avoid stone-related complications. Elderly patients with mild and moderate acute cholecystitis should undergo urgent cholecystectomy. After endoscopic retrograde cholangiography and stone extraction as well as mild acute biliary pancreatitis, cholecystectomy should be performed during the same hospital admission. Since the elevated risk of gallstone carriers to develop biliary cancer increases with age, cholecystectomy also protects against cancer.
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Affiliation(s)
- E Heger
- Medizinische Klinik II, Asklepios Klinik, Langen
| | - F Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Homburg
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Acharya V, Ngai J, Whitelaw D, Motallebzadeh R. Primary gallbladder lymphoma presenting as a polyp. BMJ Case Rep 2014; 2014:bcr-2013-202715. [PMID: 24798355 DOI: 10.1136/bcr-2013-202715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We present an unusual case of a 75-year-old woman, with no significant medical history, presenting with ongoing weight loss and change in bowel habit. Her physical examination and initial blood tests were all normal, and, therefore, radiographic imaging was undertaken. Ultrasound and CT of the abdomen confirmed a gallbladder polyp and a laparoscopic cholecystectomy was subsequently performed. Histological analysis confirmed primary gallbladder lymphoma. This case report is the first to present gallbladder lymphoma presenting as a polyp. The authors discuss the incidence, presentation and management of gallbladder lymphoma.
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Affiliation(s)
- Vikas Acharya
- Department of General Surgery, Luton and Dunstable Hospital NHS Trust, Luton, UK
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