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Knight J, Kamaya A, Fetzer D, Dahiya N, Gabriel H, Rodgers SK, Tublin M, Walsh A, Bingham D, Middleton W, Fung C. Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines. Abdom Radiol (NY) 2024; 49:3158-3165. [PMID: 38411693 DOI: 10.1007/s00261-024-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14 mm 'extremely low risk' or '7-14 mm' low risk polyps that decrease in size by ≥ 4 mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.
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Affiliation(s)
- Jessica Knight
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - David Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Scottsdale, Phoenix, AZ, 85259, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Andrew Walsh
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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Lee KC, Kim JK, Kim DK. Comparison of the Size Measurement of Gallbladder Polyps by Three Different Radiologists in Abdominal Ultrasonography. Tomography 2024; 10:1031-1041. [PMID: 39058049 PMCID: PMC11281002 DOI: 10.3390/tomography10070077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND There is little information regarding the size measurement differences in gallbladder (GB) polyps performed by different radiologists on abdominal ultrasonography (US). AIM To reveal the differences in GB polyp size measurements performed by different radiologists on abdominal US. METHODS From June to September 2022, the maximum diameter of 228 GB polyps was measured twice on abdominal US by one of three radiologists (a third-year radiology resident [reader A], a radiologist with 7 years of experience in abdominal US [reader B], and an abdominal radiologist with 8 years of experience in abdominal US [reader C]). Intra-reader agreements for polyp size measurements were assessed by intraclass correlation coefficient (ICC). A Bland-Altman plot was used to visualize the differences between the first and second size measurements in each reader. RESULTS Reader A, reader B, and reader C evaluated 65, 77, and 86 polyps, respectively. The mean size of measured 228 GB polyps was 5.0 ± 1.9 mm. Except for the case where reader A showed moderate intra-reader agreement (0.726) for polyps with size ≤ 5 mm, all readers showed an overall high intra-reader reliability (reader A, ICC = 0.859; reader B, ICC = 0.947, reader C, ICC = 0.948), indicative of good and excellent intra-reader agreements. The 95% limit of agreement of reader A, B, and C was 1.9 mm of the mean in all three readers. CONCLUSIONS GB polyp size measurement on abdominal US showed good or excellent intra-reader agreements. However, size changes of approximately less than 1.9 mm should be interpreted carefully because these may be within the measurement error.
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Affiliation(s)
- Kyu-Chong Lee
- Department of Radiology, Armed Forces Capital Hospital, Seongnam 13574, Republic of Korea; (K.-C.L.); (J.-K.K.)
- Department of Radiology, Korea University Anam Hospital, 73 Geryeodae-ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jin-Kyem Kim
- Department of Radiology, Armed Forces Capital Hospital, Seongnam 13574, Republic of Korea; (K.-C.L.); (J.-K.K.)
| | - Dong-Kyu Kim
- Department of Radiology, Armed Forces Capital Hospital, Seongnam 13574, Republic of Korea; (K.-C.L.); (J.-K.K.)
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Republic of Korea
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Kim NH, Kang JH, Kim HJ. Impact of nonalcoholic fatty liver disease on the risk of gallbladder polyps in lean and non-obese individuals: A cohort study. Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00006-7. [PMID: 38336522 DOI: 10.1016/j.hbpd.2024.01.006] [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: 06/29/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The association between non-obese or lean nonalcoholic fatty liver disease (NAFLD) and gallbladder polyps (GBPs) has not yet been evaluated. We aimed to determine whether NAFLD is an independent risk factor for the development of GBPs, even in non-obese and lean individuals. METHODS We analyzed a cohort of 331 208 asymptomatic adults who underwent abdominal ultrasonography (US). The risk of GBP development was evaluated according to the obesity and NAFLD status. RESULTS The overall prevalence of NAFLD and GBPs ≥ 5 mm was 28.5% and 2.9%, respectively. The prevalence of NAFLD among 160 276 lean, 77 676 overweight and 93 256 obese participants was 8.2%, 31.2%, and 61.1%, respectively. Individuals with NAFLD had a significantly higher incidence of GBPs with a size of ≥ 5 mm [adjusted odds ratio (OR) = 1.18; 95% confidence interval (CI): 1.11-1.25]. A higher body mass index and its categories were also significantly associated with an increased risk of GBPs ≥ 5 mm. Moreover, risk of GBPs ≥ 5 mm was significantly increased even in NAFLD individuals who are not obese (lean: adjusted OR = 1.36, 95% CI: 1.19-1.54; overweight: adjusted OR = 1.14, 95% CI: 1.03-1.26, respectively). CONCLUSIONS Non-obese/lean NAFLD is an independent risk factor for GBP development, suggesting that NAFLD may play an important role in the pathogenesis of GBPs regardless of the obesity status. Therefore, a more thorough evaluation for GBPs may be necessary when hepatic steatosis is detected on abdominal US, even in non-obese or lean individuals.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hun Kang
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Kim NH, Kim HJ, Kang JH. Impact of hepatitis B virus infection on the risk of gallbladder polyps: a cohort study. Korean J Intern Med 2023; 38:844-853. [PMID: 37848340 PMCID: PMC10636554 DOI: 10.3904/kjim.2023.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND/AIMS We aimed to determine whether hepatitis B virus (HBV) or hepatitis C virus (HCV) infection remains an important risk factor for gallbladder polyps (GBPs) in the current context of reduced prevalence of these infections. METHODS The cohort included 392,913 asymptomatic adults who underwent abdominal ultrasonography (US). RESULTS The prevalence of GBP sized ≥ 5 mm, ≥ 10 mm, and overall (< 5, 5-9 and ≥ 10 mm) was 2.9%, 0.1%, and 12.8%, respectively. The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and hepatitis C antibody (anti-HCV) positivity was 3.2%, 26.7%, and 0.1%, respectively. The GBP risk was significantly increased in HBsAg-positive individuals, with an adjusted odds ratio of 1.66 (95% confidence interval, 1.49-1.85) for GBP ≥ 5 mm, 2.39 (1.53-3.75) for GBP ≥ 10 mm, and 1.49 (1.41-1.59) for overall, whereas there was no significant association between anti-HCV positivity and GBP risk. The GBP risk did not increase significantly in individuals who tested negative for HBsAg but positive for HBcAb. CONCLUSION The presence of HBsAg may be an independent risk factor for GBP development in the current context of a indecreasing prevalence of HBsAg positivity. A more comprehensive evaluation of GBP during abdominal US surveillance of HBsAg-positive individuals may be necessary.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hun Kang
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Kim NH, Kang JH, Kim HJ. Differences in the Impact of Obesity and Metabolic Unhealthiness on the Risk of Gallbladder Polyp. Yonsei Med J 2023; 64:658-664. [PMID: 37880846 PMCID: PMC10613762 DOI: 10.3349/ymj.2023.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Differences in the impact of obesity and metabolic health status on the risk of gallbladder polyp (GBP) remain uncertain. Herein, we aimed to compare the risk of GBP ≥5 mm among individuals with different phenotypes based on obesity and metabolic health status. MATERIALS AND METHODS A cohort of 253485 asymptomatic adults who underwent abdominal ultrasonography screening were categorized into the following four groups according to obesity and metabolic health status: 1) metabolically healthy non-obese (MHNO), 2) metabolically unhealthy and non-obese (MUNO), 3) metabolically healthy but obese (MHO), and 4) metabolically unhealthy obese (MUO). RESULTS The prevalences of GBP ≥5 mm were 2.4%, 3.1%, 3.7%, and 4.0% in the MHNO, MUNO, MHO, and MUO groups, respectively. The multivariable-adjusted odds ratio (OR) values for prevalence of GBP ≥5 mm by comparing the MUNO, MHO, and MUO with the MHNO group were 1.11 [95% confidence interval (CI), 1.04-1.19], 1.30 (95% CI, 1.15-1.47), and 1.37 (95% CI, 1.28-1.45), respectively. The risk of GBP ≥5 mm in the MHO group was significantly higher than that in the MUNO group, but not significantly different from that in the MUO group. CONCLUSION Obesity and metabolic unhealthiness appear to be independent risk factors for the prevalence of GBP, and the impact of obesity is greater than that of metabolic unhealthiness, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of GBP.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hun Kang
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Yıldırım HÇ, Kavgaci G, Chalabiyev E, Dizdar O. Advances in the Early Detection of Hepatobiliary Cancers. Cancers (Basel) 2023; 15:3880. [PMID: 37568696 PMCID: PMC10416925 DOI: 10.3390/cancers15153880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Hepatocellular cancer (HCC) and biliary tract cancers (BTCs) have poor survival rates and a low likelihood of a cure, especially in advanced-stage disease. Early diagnosis is crucial and can significantly improve survival rates through curative treatment approaches. Current guidelines recommend abdominal ultrasonography (USG) and alpha-fetoprotein (AFP) monitoring for HCC screening in high-risk groups, and abdominal USG, magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) monitoring for biliary tract cancer. However, despite this screening strategy, many high-risk individuals still develop advanced-stage HCC and BTC. Blood-based biomarkers are being developed for use in HCC or BTC high-risk groups. Studies on AFP, AFP-L3, des-gamma-carboxy prothrombin, glypican-3 (GPC3), osteopontin (OPN), midkine (MK), neopterin, squamous cell carcinoma antigen (SCCA), Mac-2-binding protein (M2BP), cyclic guanosine monophosphate (cGMP), and interleukin-6 biomarkers for HCC screening have shown promising results when evaluated individually or in combination. In the case of BTCs, the potential applications of circulating tumor DNA, circulating microRNA, and circulating tumor cells in diagnosis are also promising. These biomarkers have shown potential in detecting BTCs in early stages, which can significantly improve patient outcomes. Additionally, these biomarkers hold promise for monitoring disease progression and evaluating response to therapy in BTC patients. However, further research is necessary to fully understand the clinical utility of these biomarkers in the diagnosis and management of HCC and BTCs.
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Affiliation(s)
| | | | | | - Omer Dizdar
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey; (H.Ç.Y.); (G.K.); (E.C.)
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Zhang J, Wu Y, Feng Y, Fu J, Jia N. The value of CT findings combined with inflammatory indicators for preoperative differentiation of benign and malignant gallbladder polypoid lesions. World J Surg Oncol 2023; 21:51. [PMID: 36803518 PMCID: PMC9938612 DOI: 10.1186/s12957-023-02941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/11/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The study aimed to explore the value of CT findings and inflammatory indicators in differentiating benign and malignant gallbladder polypoid lesions before surgery. METHODS The study comprised a total of 113 pathologically confirmed gallbladder polypoid lesions with a maximum diameter ≥ 1 cm (68 benign and 45 malignant), all of which were enhanced CT-scanned within 1 month before surgery. The CT findings and inflammatory indicators of the patients were analyzed by univariate and multivariate logistic regression analysis to identify independent predictors of gallbladder polypoid lesions, and then a nomogram distinguishing benign and malignant gallbladder polypoid lesions was developed by combining these characteristics. The receiver operating characteristic (ROC) curve and decision curve were plotted to assess the performance of the nomogram. RESULTS Base status of the lesion (p < 0.001), plain CT value (p < 0.001), neutrophil-lymphocyte ratio (NLR) (p = 0.041), and monocyte-lymphocyte ratio (MLR) (p = 0.022) were independent predictors of malignant polypoid lesions of the gallbladder. The nomogram model established by incorporating the above factors had good performance in differentiating and predicting benign and malignant gallbladder polypoid lesions (AUC = 0.964), with sensitivity and specificity of 82.4% and 97.8%, respectively. The DCA demonstrated the important clinical utility of our nomogram. CONCLUSION CT findings combined with inflammatory indicators can effectively differentiate benign and malignant gallbladder polypoid lesions before surgery, which is valuable for clinical decision-making.
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Affiliation(s)
- Juan Zhang
- grid.414375.00000 0004 7588 8796Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, No.225 Changhai, Shanghai, 200433 China
| | - Yuxian Wu
- grid.414375.00000 0004 7588 8796Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, No.225 Changhai, Shanghai, 200433 China
| | - Yayuan Feng
- grid.414375.00000 0004 7588 8796Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, No.225 Changhai, Shanghai, 200433 China
| | - Jiazhao Fu
- Department of Organ Transplantation, Changhai Hospital, First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
| | - Ningyang Jia
- Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, No.225 Changhai, Shanghai, 200433, China.
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Han JW, Choi YH, Lee IS, Choi HJ, Hong TH, You YK. Gallbladder polyps growth rate is an independent risk factor for neoplastic polyps. United European Gastroenterol J 2022; 10:651-656. [PMID: 36087036 PMCID: PMC9486499 DOI: 10.1002/ueg2.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The size of gallbladder (GB) polyps is a representative risk factor for neoplastic polyps. However, whether growth rate during follow‐up is associated with neoplastic polyps remains unclear. Methods From 2009 to 2019, a cohort of patients with GB polyps who underwent cholecystectomy was enrolled. We included only patients who underwent at least two abdominal ultrasonography procedures at least 6 months apart prior to cholecystectomy. Performance and optimal cutoff value of polyp growth rate for predicting neoplastic polyps were estimated using receiver operating characteristic (ROC) analysis. In addition to growth rate, several other variables considered suitable for predicting neoplastic polyps were also investigated. A nomogram was created to predict neoplastic polyps. Results A total of 239 patients with neoplastic polyps (n = 27, 11.3%) and non‐neoplastic polyps (n = 212, 88.7%) were included. The median follow‐up period was 28.5 months. The area under the ROC curve (AUROC) of polyp growth rate for neoplastic polyps was 0.66 (95% confidence interval, 0.59–0.72). The growth rate cutoff value for prediction of neoplastic polyps was 3 mm/year (sensitivity, 37.0%; specificity, 86.3%). Multivariate analysis identified several factors predicting neoplastic polyps: polyp size ≥10 mm (odds ratio [OR], 3.74, p = 0.041), solitary polyp (OR, 3.92, p = 0.004), and polyp growth rate ≥ 3 mm/year (OR, 2.75, p = 0.031). The AUROC of the nomogram using these three significant factors in multivariate analysis was 0.71. Conclusion GB polyps with a growth rate of over 3 mm per year on ultrasonography during follow‐up should be considered a risk factor for neoplastic polyps.
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Affiliation(s)
- Ji Won Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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A New Risk Scoring System to Predict Malignancy in Gallbladder Polyps: a Single-Center Study. J Gastrointest Surg 2022; 26:1846-1852. [PMID: 35581462 DOI: 10.1007/s11605-022-05351-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/30/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Ultrasonography (US) is the most commonly used radiological method in the diagnosis of gallbladder polyps (GBPs). Patients diagnosed with GBPs on US are operated on with risk factors that do not have a high level of evidence. Our aim in this study is to determine the sensitivity of US in diagnosis GBPs, to define risk factors for neoplastic (NP) polyps, and to develop the risk scoring system. MATERIALS AND METHODS Between July 2011 and July 2021, 173 patients who were found to have GBPs in the pathology specimens after cholecystectomy were included in the study. Patients were divided into two groups: nonneoplastic and NP groups. RESULTS GBPs in patients who underwent abdominal US for any reason was 4.5%. The sensitivity of US in the diagnosis of GBPs was 56.6%. Comparison between groups, age ≥50, presence of symptoms, polyp size >12.5mm, single polyp, concomitant gallstones, and gallbladder wall thickness ≥4mm were statistically in the NP group. A risk scoring system was developed using these values. If the risk score was <4, 0.6% of GBPs was NP polyps. If the risk score was ≥4, 63.2% of GBPs were NP polyps. CONCLUSION Our risk scoring system can prevent unnecessary choelcystectomy. Because the incidence of NP polyps in low-risk patients (risk score <4) is extremely rare.
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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: 0.5] [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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Lin SH, Wu KT, Chiu YC, Wang CC, Chiu KW. Risk factors for gallbladder polyps observed through second-look abdominal sonography in patients with fatty liver disease. Medicine (Baltimore) 2022; 101:e29643. [PMID: 35905261 PMCID: PMC9333503 DOI: 10.1097/md.0000000000029643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
FLD, older age group, and alcohol consumption are major risk factors of GBP formation in Taiwanese population. The presence of GBPs might be revealed in second-look examinations of abdominal sonographies.
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Affiliation(s)
- Shu-Hsien Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Ta Wu
- Division of General Surgery, Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Liver Transplantation Centre, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - King-Wah Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Liver Transplantation Centre, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- *Correspondence: King-Wah Chiu, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, No. 123, Tai-Pei Road, Niao-Sung District, Kaohsiung 83305, Taiwan, ROC (e-mail: )
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Ghartimagar D, Shrestha MK, Ruwanpathirana RE, Purbe D, Mishra S. Incidental finding of a large polypoidal gallbladder mass diagnosed as papillary adenocarcinoma – A case report. Int J Surg Case Rep 2022; 94:107046. [PMID: 35421724 PMCID: PMC9019258 DOI: 10.1016/j.ijscr.2022.107046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Polypoid lesions of gallbladder are discovered incidentally. Presenting symptoms are mostly nonspecific. Ultrasonography of abdomen on routine health check-up showed the lesion. Most of the lesions are benign in nature but few present with malignant features. Polyps larger than 1 cm in size have higher chance of malignancy.
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Affiliation(s)
- Dilasma Ghartimagar
- Department of Pathology, Manipal College of Medical Science, Pokhara, Nepal.
| | | | | | - Dipika Purbe
- Department of Pathology, Manipal College of Medical Science, Pokhara, Nepal
| | - Sushil Mishra
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal
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13
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Wang X, Zhu JA, Liu YJ, Liu YQ, Che DD, Niu SH, Gao S, Chen DB. Conventional Ultrasound Combined With Contrast-Enhanced Ultrasound in Differential Diagnosis of Gallbladder Cholesterol and Adenomatous Polyps (1-2 cm). JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:617-626. [PMID: 33938029 DOI: 10.1002/jum.15740] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS). METHODS Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors. RESULTS There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P < .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P < .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%. CONCLUSIONS The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.
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Affiliation(s)
- Xue Wang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jia-An Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yue-Jie Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yi-Qun Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Dong-Dong Che
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Si-Hua Niu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Ding-Bao Chen
- Department of Pathology, Peking University People's Hospital, Beijing, China
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14
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Fosio M, Cherobin G, Stramare R, Fassan M, Giraudo C. Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps. Diagnostics (Basel) 2022; 12:diagnostics12010155. [PMID: 35054322 PMCID: PMC8774625 DOI: 10.3390/diagnostics12010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Axial MR image demonstrating multiple small gallbladder polypoid lesions characterized by contrast enhancement in a 78-year-old male hospitalized for acute chest pain due to coronary artery disease who showed fever and emesis during hospitalization and had signs of acute acalculous cholecystitis at computed tomography. Given the overall clinical conditions and the MR features, the inflammatory origin of the polyps was considered. The patient underwent cholecystectomy and the histological diagnosis of gallbladder inflammatory pseudopolyps was confirmed. This rare entity represents 5–10% of all gallbladder polyps, and their differentiation from benign and malignant tumors might be challenging especially in acalculous patients, thus surgery is often performed.
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Affiliation(s)
- Margherita Fosio
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Giulia Cherobin
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Roberto Stramare
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Matteo Fassan
- Surgical Pathology, Department of Medicine, University of Padova, 35121 Padova, Italy;
- Veneto Institute of Oncology, IOV-IRCCS, 35128 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
- Correspondence:
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15
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Jang SI, Kim YJ, Kim EJ, Kang H, Shon SJ, Seol YJ, Lee DK, Kim KG, Cho JH. Diagnostic performance of endoscopic ultrasound-artificial intelligence using deep learning analysis of gallbladder polypoid lesions. J Gastroenterol Hepatol 2021; 36:3548-3555. [PMID: 34431545 DOI: 10.1111/jgh.15673] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasound (EUS) is the most accurate diagnostic modality for polypoid lesions of the gallbladder (GB), but is limited by subjective interpretation. Deep learning-based artificial intelligence (AI) algorithms are under development. We evaluated the diagnostic performance of AI in differentiating polypoid lesions using EUS images. METHODS The diagnostic performance of the EUS-AI system with ResNet50 architecture was evaluated via three processes: training, internal validation, and testing using an AI development cohort of 1039 EUS images (836 GB polyps and 203 gallstones). The diagnostic performance was verified using an external validation cohort of 83 patients and compared with the performance of EUS endoscopists. RESULTS In the AI development cohort, we developed an EUS-AI algorithm and evaluated the diagnostic performance of the EUS-AI including sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. For the differential diagnosis of neoplastic and non-neoplastic GB polyps, these values for EUS-AI were 57.9%, 96.5%, 77.8%, 91.6%, and 89.8%, respectively. In the external validation cohort, we compared diagnostic performances between EUS-AI and endoscopists. For the differential diagnosis of neoplastic and non-neoplastic GB polyps, the sensitivity and specificity were 33.3% and 96.1% for EUS-AI; they were 74.2% and 44.9%, respectively, for the endoscopists. Besides, the accuracy of the EUS-AI was between the accuracies of mid-level (66.7%) and expert EUS endoscopists (77.5%). CONCLUSIONS This newly developed EUS-AI system showed favorable performance for the diagnosis of neoplastic GB polyps, with a performance comparable to that of EUS endoscopists.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University College of Health Science, Incheon, South Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Huapyong Kang
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seung Jin Shon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yu Jin Seol
- Department of Biomedical Engineering, Gachon University College of Health Science, Incheon, South Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gachon University College of Health Science, Incheon, South Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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16
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Yin SN, Shen GH, Liu L, Chi J, Ding N, Ji YD, Yuan JM. Triphasic dynamic enhanced computed tomography for differentiating cholesterol and adenomatous gallbladder polyps. Abdom Radiol (NY) 2021; 46:4701-4708. [PMID: 34170333 DOI: 10.1007/s00261-021-03173-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Triphasic dynamic enhanced computed tomography (CT) scans were acquired to identify cholesterol and adenomatous gallbladder (GB) polyps that were inaccurately diagnosed before surgery. PURPOSE To evaluate the CT findings of 1.0- to 2.0-cm GB polyps for differentiating between cholesterol and adenomatous polyps. METHODS Fifty-two patients with GB polyps were treated surgically from December 2017 to July 2020 and were retrospectively divided into 2 groups according to the postoperative pathologic results: a cholesterol group with 30 patients and an adenomatous group with 22 patients. Unenhanced and triphasic dynamic enhanced CT scans were performed for all the patients within 2 weeks before surgery. The CT image parameters were measured and analyzed by 2 senior radiologists blinded to the pathological diagnoses. RESULTS Of the 22 patients in the adenomatous group, 77.3% were female and 22.7% were male, with a mean age of 53.5 years; among the 30 patients in the cholesterol group, 66.7% were female and 33.3% were male, with a median age of 50.1 years. The CT image parameters of all 52 patients with GB polyps were analyzed. Significant differences were found in the arterial phase CT values, portal venous phase CT values, delayed phase CT values, ∆CT1 values (portal venous phase CT minus delayed phase CT values), and ∆CT2 values (arterial phase CT minus delayed phase CT values) between the cholesterol and adenomatous polyp groups (p < 0.05). In differentiating the two groups, the ∆CT1 and ∆CT2 values were superior to the arterial, portal venous and delayed phase CT values regarding both sensitivity and specificity. CONCLUSION The arterial phase CT values, portal venous phase CT values, delayed phase CT values, and ∆CT values (including ∆CT1 and ∆CT2) from triphasic dynamic enhanced CT scans can differentiate the nature of gallbladder polypoid lesions, with the ∆CT values having the highest sensitivity and specificity.
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Affiliation(s)
- Sheng Nan Yin
- Department of Medical Imaging, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China
| | - Gen Hai Shen
- Department of Surgery, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China
| | - Li Liu
- Department of Medical Imaging, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China
| | - Jing Chi
- Department of Medical Imaging, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China
| | - Ning Ding
- Department of Medical Imaging, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China
| | - Yi Ding Ji
- Department of Medical Imaging, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China.
| | - Jian Mao Yuan
- Department of Medical Imaging, Suzhou Ninth People's Hospital, No.2666, Ludang Road, Wujiang, 215200, Jiangsu, China
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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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Lee YJ, Park B, Hong KW, Jung DH. Gallbladder Polyps Increase the Risk of Ischaemic Heart Disease Among Korean Adults. Front Med (Lausanne) 2021; 8:693245. [PMID: 34490291 PMCID: PMC8418136 DOI: 10.3389/fmed.2021.693245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Gallbladder (GB) polyps and ischaemic heart disease (IHD) share some common risk factors. We investigated the longitudinal effects of gallbladder (GB) polyps, as a surrogate metabolic indicator, on IHD. Methods: We enrolled 19,612 participants from the health risk assessment study (HERAS) and Korean Health Insurance Review and Assessment Service (HIRA) database. The primary outcome was IHD, which consisted of angina pectoris (ICD-10 code I20) or acute myocardial infarction (ICD-10 code I21) that occurred after enrolment into the study. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD according to the presence of GB polyps using multivariate Cox proportional hazards regression models. Results: The median follow-up period was 29.9 months and a total of 473 individuals (2.4%, 473/19,612) developed IHD. Individuals with GB polyps had an increased risk of IHD compared with the control group after adjusting for potential confounding variables (HR = 1.425; 95% CI, 1.028–1.975). Furthermore, the coexistence of hypertension or dyslipidaemia resulted in an increased risk (HR = 2.14, 95% CI, 1.34–3.44 or HR = 2.09, 95% CI, 1.32–3.31, respectively) of new-onset IHD in the GB polyp group. Conclusions: GB polyps was an independent risk factor of IHD. Awareness of these associations will inform clinicians on the need to include cardiovascular risk management as part of the routine management of patients with GB polyps.
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Affiliation(s)
- Yong-Jae Lee
- Department of Family Medicine, Gangnam Severance Hospital, Seoul, South Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yongin, South Korea
| | | | - Dong-Hyuk Jung
- Department of Family Medicine, Yongin Severance Hospital, Yongin, South Korea
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Kwon OS, Kim YK. Are there modifiable risk factors affecting the prevalence of gallbladder polyps or those 5 mm or larger? A retrospective cross-sectional study. Medicine (Baltimore) 2021; 100:e27115. [PMID: 34477153 PMCID: PMC8415951 DOI: 10.1097/md.0000000000027115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/14/2021] [Indexed: 02/07/2023] Open
Abstract
Gallbladder polyps (GBPs), especially GBPs ≥5 mm in diameter, are clinically important because they can progress to gallbladder cancer. The known modifiable risk factors for GBP are obesity, metabolic syndrome, and dyslipidemia; however, there is limited evidence regarding specific modifiable risk factors for GBPs ≥5 mm in diameter. Therefore, this study is aimed to investigate the existence of modifiable risk factors affecting the prevalence of GBPs and GBPs ≥5 mm in diameter in a Korean population.A total of 10,119 subjects who visited a single health-screening center at Jeju National University Hospital between January 2009 and December 2019 was included in this study. Binary logistic analyses were performed to identify risk factors affecting the prevalence of GBPs and GBPs ≥5 mm in diameter.The overall prevalence of GBPs and GBPs ≥5 mm in diameter were 9.0% and 4.1%, respectively. Multivariable analysis identified male gender as an independent risk factor affecting the prevalence of GBPs. Moreover, multivariable analysis revealed age and high-density lipoprotein cholesterol levels as independent risk factors for GBPs ≥5 mm in diameter.This study showed that gender was a risk factor affecting the prevalence of GBPs and that age and high-density lipoprotein-cholesterol levels were risk factors for the presence of GBPs ≥5 mm in diameter. High-density lipoprotein cholesterol levels could be a modifiable risk factor affecting the prevalence of large-diameter GBPs.
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Affiliation(s)
- Oh-Sung Kwon
- Department of Medical Information, Jeju National University Hospital, Jeju-si, Jeju Special Self-Governing Province, Republic of Korea
| | - Young-Kyu Kim
- Department of Surgery, Jeju National University School of Medicine, Aran 13gil 15 (Ara-1Dong) Jeju-si, Jeju Special Self-Governing Province, Republic of Korea
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20
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Fei X, Li N, Zhu L, Han P, Jiang B, Tang W, Sang M, Zhang X, Luo Y. Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion. Eur Radiol 2021; 31:6717-6725. [PMID: 33569621 DOI: 10.1007/s00330-021-07730-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/10/2020] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the diagnostic value of high frame rate contrast-enhanced ultrasound (H-CEUS) in distinguishing gallbladder adenomas from cholesterol polyp lesions with that of CEUS. METHODS This study enrolled 94 patients with gallbladder polyp lesions (GPLs) who underwent laparoscopic cholecystectomy. CEUS and H-CEUS were performed before surgery. The perfusion features of GPLs and the final diagnosis as determined by both technologies were compared. RESULTS There were differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on H-CEUS (p < 0.05), while there were no differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on CEUS (p > 0.05). In the cholesterol polyp lesion group, there were no differences in vascular types between CEUS and H-CEUS (p > 0.05), while the vascular types were different between CEUS and H-CEUS in the gallbladder adenoma group (p < 0.05). The diagnostic value of H-CEUS in distinguishing gallbladder adenomas from cholesterol polyp lesions was better than that of CEUS. CONCLUSIONS H-CEUS improved the time resolution by increasing the frame rate, which helped to accurately reflect the difference in the microcirculation of GPLs and improved the ability of a differential diagnosis between cholesterol polyp lesions and adenomas. H-CUES may provide an effective means of imaging for patients with GPLs regarding the choice of treatment options. KEY POINTS • High frame rate CEUS improves the time resolution of CEUS by increasing the frame rate. • High frame rate CEUS is helpful to accurately evaluate the microvascular morphology of a gallbladder polyp lesion in the arterial phase. • High frame rate CEUS helps patients with gallbladder polyp lesions to choose the appropriate treatment means.
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Affiliation(s)
- Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wenbo Tang
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Maodong Sang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nanshan District, Shenzhen, 518055, China
| | - Xirui Zhang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nanshan District, Shenzhen, 518055, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, 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: 6] [Impact Index Per Article: 2.0] [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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22
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Akbulut S, Sahin TT. Comment on gallbladder polyps: Correlation of size and clinicopathologic characteristics based on updated definitions. Int J Surg Case Rep 2021; 83:105947. [PMID: 34015684 PMCID: PMC8141456 DOI: 10.1016/j.ijscr.2021.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023] Open
Abstract
• There was strong correlation between polyp diameter (≥ 10 mm vs <10 mm) and the risk of gallbladder cancer (OR=54; r=0.704). • There was moderate correlation between polyp diameter (10-19 mm vs <10 mm) and the risk of gallbladder cancer (OR=23; r=0.534). • There was moderate correlation between polyp diameter (≥ 20 mm vs <20 mm) and the risk of gallbladder cancer (OR=300; r=0.559). • There was moderate correlation between polyp diameter (≥ 20 mm vs <10 mm) and the risk of gallbladder cancer (OR=551; r=0.697). • Our results suggest that as the diameter of the polyp reaches 20 mm, it is necessary to plan a surgical treatment strategy as if the patient has gallbladder cancer.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University, Faculty of Medicine, 244280, Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University, Faculty of Medicine, 244280, Malatya, Turkey.
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Gautam A, Pandey A, Masood S, Chauhan S, Choudhary D, Kumar S, Madhawan S, Jha S, Saini V. Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population. Malays J Med Sci 2021; 28:27-34. [PMID: 33679217 PMCID: PMC7909354 DOI: 10.21315/mjms2021.28.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Gallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population. Methods A retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used. Results Of 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031). Conclusion Cholecystectomy needs to be considered early in the management of small-sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.
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Affiliation(s)
- Abhishek Gautam
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshuman Pandey
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shakeel Masood
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Smita Chauhan
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinesh Choudhary
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Suneed Kumar
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shibumon Madhawan
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sneha Jha
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vijay Saini
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Cunha R, Parreira R, Quintanilha R, Carneiro V, Medeiros A, Leite I. Heterotopic gastric mucosa in the gallbladder-a rare find. J Surg Case Rep 2020; 2020:rjaa490. [PMID: 33343867 PMCID: PMC7737002 DOI: 10.1093/jscr/rjaa490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
It is universally known and accepted that the development of a certain type of tissue outside its usual location, like in the gastrointestinal tract, can occur. This is a relatively common situation in the upper region of the gastrointestinal tract. However, the development of gastric mucosa in the gallbladder is a rare find. The following is the case of a 22-year-old male with an 18 mm gallbladder polyp, who electively underwent a laparoscopic cholecystectomy, having been diagnosed at a histopathological level with heterotopic gastric mucosa in the gallbladder. This brief article also aims to provide a reflection on the possible evolution of neoplasms from this histological change, based on the doubts raised in literature.
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Affiliation(s)
- Roberto Cunha
- Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Rafaela Parreira
- General Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Rui Quintanilha
- General Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Vítor Carneiro
- Pathologic Anatomy Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Armando Medeiros
- General Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
| | - Inês Leite
- General Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal
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Corten BJGA, Leclercq WKG, van Zwam PH, Roumen RMH, Dejong CH, Slooter GD. Method for adequate macroscopic gallbladder examination after cholecystectomy. Acta Chir Belg 2020; 120:442-450. [PMID: 32701051 DOI: 10.1080/00015458.2020.1785219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS There is no clear guideline nor protocol for macroscopic examination of the gallbladder, leaving surgeons extemporaneous in regard of gallbladder examination in selective histopathologic policy. The purpose of this article is to describe a surgical approach for adequate macroscopic inspection of the gallbladder. MATERIALS AND METHODS The described practical method was developed in collaboration between surgeons and pathologists. This method was introduced in 2011 and implemented in 2012. We retrospectively reviewed the number of cholecystectomies and number of histopathologic examinations between 2006 and 2017, using our own patient database. We used the Netherlands Cancer Registry (NCR) to examine the incidence of gallbladder cancer patients before and after implementation of the selective policy in our hospital. In addition to the method, we depict several frequent macroscopic abnormalities in order to provide some examples for surgical colleagues. RESULTS Since implementation of the selective policy, 2271 surgical macroscopic gallbladder examinations were performed. As a result, we observed a significant decrease from 83% in 2012 to 38% in 2017, in histopathologic examination of the gallbladder following cholecystectomy. We observed a stable trend of gallbladder carcinoma in the same period (0.17%, n = 4 during 2006-2011 and 0.26%, n = 6 during 2012-2017). CONCLUSION A simple, valid and easy method is described for future macroscopic analysis by the surgeon following a cholecystectomy.
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Affiliation(s)
- Bartholomeus J. G. A. Corten
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Peter H. van Zwam
- Department of Pathology, PAMM laboratory for pathology and medical microbiology, Eindhoven, The Netherlands
| | - Rudi M. H. Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Cees H. Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Gerrit D. Slooter
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
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26
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Lee KF, Hung EHY, Leung HHW, Lai PBS. A narrative review of gallbladder adenomyomatosis: what we need to know. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1600. [PMID: 33437799 PMCID: PMC7791251 DOI: 10.21037/atm-20-4897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gallbladder adenomyomatosis (GA) is increasingly encountered in clinical practice due to increasing use of imagings especially ultrasound (US). Clinicians need to know what is the implication of this condition and its proper management. GA is a degenerative and proliferative disease characterized by excessive epithelial proliferation associated with hypertrophy of muscularis propria. This leads to outpouchings of mucosa into or beyond the muscle layer forming intramural diverticula recognized as Rokitansky-Aschoff sinuses (RAS). Three types of GA are recognised: fundal, segmental and diffuse type. In fundal GA, there is focal thickening involving the GB fundus. In segmental GA, there is circumferential overgrowth of the GB wall that leads to formation of compartments. In diffuse GA, there is disseminated thickening and irregularity of the mucosa and muscularis. The pathogenesis of GA is unknown. It commonly occurs in middle age with equal sex distribution. Diagnosis of GA is by imagings showing thickened gallbladder wall containing cysts. Characteristic features are “comet-tail” artefacts and “twinkling” artefacts on US, “pearl-necklace sign” on magnetic resonance imaging (MRI) and “rosary sign” on computed tomography (CT). Cholecystectomy should be offered for symptomatic GA of any type. For asymptomatic GA, cholecystectomy may be considered for segmental type for its increased risk of malignancy and for diffuse type for its difficult visualization of any coexisting malignancy. Asymptomatic fundal GA can be safely observed with US. How frequent and how long should a fundal GA be monitored with US remains unknown. In case of diagnostic doubt, cholecystectomy should always be offered to avoid overlooked malignancy.
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Affiliation(s)
- Kit-Fai Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Esther H Y Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Howard H W Leung
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Paul B S Lai
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
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Ahn DW, Jeong JB, Kang J, Kim SH, Kim JW, Kim BG, Lee KL, Oh S, Yoon SH, Park SJ, Lee DH. Fatty liver is an independent risk factor for gallbladder polyps. World J Gastroenterol 2020; 26:6979-6992. [PMID: 33311944 PMCID: PMC7701938 DOI: 10.3748/wjg.v26.i44.6979] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallbladder polyps (GBPs) are known to be associated with obesity and metabolic diseases. However, to date, the relationship between GBPs and abnormal body fat distribution, such as fatty liver, visceral obesity, or sarcopenia, has not yet been established.
AIM To evaluate whether GBPs are associated with fatty liver, visceral obesity, or sarcopenia.
METHODS We retrospectively reviewed the medical records of subjects who underwent various laboratory tests, body composition measurement with a non-invasive body composition analyzer, and abdominal ultrasonography during health checkups. A total of 1405 subjects with GBPs were compared with 2810 age- and sex-matched controls.
RESULTS The mean age of the subjects was 46.8 ± 11.7 years, and 63.8% were male. According to multiple logistic regression analysis, the presence of fatty liver [odds ratio (OR) 1.413; 95% confidence interval (CI) 1.218-1.638; P < 0.001] was an independent risk factor for GBP, together with low levels of alanine aminotransferase (OR 0.993; 95%CI 0.989-0.996; P < 0.001). Additionally, fatty liver showed both independent (OR 1.629; 95%CI, 1.335-1.988; P < 0.001) and dose-dependent (moderate to severe fatty liver; OR 2.137; 95%CI, 1.662-2.749; P < 0.001) relationship with large GBPs (≥ 5 mm). The presence of sarcopenia and high visceral fat area were not significantly associated with GBPs.
CONCLUSION Fatty liver was found to be closely associated with GBPs irrespective of sarcopenia and visceral obesity.
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Affiliation(s)
- Dong-Won Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Ji Bong Jeong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Jinwoo Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Su Hwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Ji Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Byeong Gwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Kook Lae Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Sohee Oh
- Department of Biostatistics, Medical Research Collaborating Center, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Sang Joon Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Doo Hee Lee
- Department of Research and Development, MEDICALIP Co. Ltd., Seoul 03127, South Korea
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28
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Kim KH. Gallbladder polyps: evolving approach to the diagnosis and management. Yeungnam Univ J Med 2020; 38:1-9. [PMID: 33045805 PMCID: PMC7787897 DOI: 10.12701/yujm.2020.00213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Gallbladder (GB) polyp is a mucosal projection into the GB lumen. With increasing health awareness, GB polyps are frequently found using ultrasonography during health screening. The prevalence of GB polyps ranges between 1.3% and 9.5%. Most patients are asymptomatic and have benign characteristics. Of the nonneoplastic polyps, cholesterol polyps are most common, accounting for 60%-70% of lesions. However, a few polyps have malignant potential. Currently, the guidelines recommend laparoscopic cholecystectomy for polyps larger than 1 cm in diameter due to their malignan potential. The treatment algorithm can be influenced by the size, shape, and numbers of polyps, old age (>50 years), the presence of primary sclerosing cholangitis, and gallstones. This review summarizes the commonly recognized concepts on GB polyps from diagnosis to an algorithm of treatment.
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Affiliation(s)
- Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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29
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Zhang J, Zhang Y, Chen Y, Chen W, Xu H, Sun W. Helicobacter pylori is not a contributing factor in gallbladder polyps or gallstones: a case-control matching study of Chinese individuals. J Int Med Res 2020; 48:300060520959220. [PMID: 33045881 PMCID: PMC7557694 DOI: 10.1177/0300060520959220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/24/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship between Helicobacter pylori (H. pylori) infection and gallstones or gallbladder polyps. METHODS This retrospective analysis included 27,881 individuals who underwent health examinations that included a H. pylori test and an abdominal ultrasound scan. Patients were divided into four groups: gallbladder polyp (P group), gallstone (S group), gallstone and gallbladder polyp (SP group), and no gallbladder disease (N group). Case-control matching was used to select the participants in the control group. RESULTS The mean ages of participants in the P, S, and SP groups were all significantly higher than the mean age of participants in the N group. The proportions of participants with each type of body mass index significantly differed between the N and P groups, and between the N and S groups. In total 45.7% of participants exhibited H. pylori infection. After case-control matching, the proportion of participants with H. pylori infection did not significantly differ according to the presence or absence of gallbladder polyps. Similar results were observed regarding gallstones, as well as gallstones and gallbladder polyps. CONCLUSION H. pylori infection might not be related to gallbladder polyps or gallstones.
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Affiliation(s)
- Jinshun Zhang
- Health Management Center, Taizhou Hospital, Linhai, China
| | - Ying Zhang
- School of Foreign Languages, Taizhou University, Linhai,
China
| | - Yahong Chen
- Health Management Center, Taizhou Hospital, Linhai, China
| | - Weiling Chen
- Health Management Center, Taizhou Hospital, Linhai, China
| | - Hongfang Xu
- Health Management Center, Taizhou Hospital, Linhai, China
| | - Wei Sun
- Health Management Center, Taizhou Hospital, Linhai, China
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Abstract
SummaryA gallbladder polyp (GP) is defined as an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen. Gallbladder polyps (GPs) have an estimated prevalence in adults of 0.3–12.3%. However, only 5% of polyps are considered “true” GPs that have malignant potential or are even already cancerous. The most important imaging method for diagnosis and follow-up of GPs is transabdominal ultrasound, but it fails to discriminate between true and pseudo polyps at a clinically relevant level. Although gallbladder cancer (GBC) arising from polyps is a rare event, malignancy is significantly more common among polyps from a size of 10 mm. In light of this, the consensus, which is reflected in current guidelines, is that surgery should be considered for polyps of 10 mm or greater. However, 10 mm is an arbitrary cutoff, and high-quality evidence to support this is lacking. Lowering the threshold for cholecystectomy when patients have additional risk factors for gallbladder malignancy may improve the cancer detection rate in polyps smaller than 10 mm. Nevertheless, the evidence behind this is also weak. This review shows the shortcomings in the available evidence and underlines the decision-making process regarding the surgical indication, surveillance, or both.
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31
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Yang X, Liu Y, Guo Y, Chai R, Niu M, Xu K. Utility of radiomics based on contrast-enhanced CT and clinical data in the differentiation of benign and malignant gallbladder polypoid lesions. Abdom Radiol (NY) 2020; 45:2449-2458. [PMID: 32166337 DOI: 10.1007/s00261-020-02461-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To develop and validate a novel method based on radiomics for the preoperative differentiation of benign and malignant gallbladder polypoid lesions (PLG). PATIENTS AND METHODS A total of 145 patients with pathological proven gallbladder polypoid lesions ≥ 1 cm were included in this retrospective study. All the patients underwent abdominal contrast-enhanced computed tomography (CT) examinations 3 weeks before cholecystectomy from January 2013 to January 2019. Seventy percent of the cases were randomly selected for the training dataset, and 30% of the cases were independently used for testing. Radiomics features extracted from portal venous-phase CT of the PLG and clinical features were analyzed, and the LASSO regression algorithm was used for data dimension reduction. Multivariable logistic regression was used to generate radiomics signatures, clinical signatures, and combination signatures. The receiver operating characteristic (ROC) curve and decision curve were plotted to assess the differentiating performance of the three signatures. RESULTS The area under the ROC curve (AUC) of the radiomics signature and clinical signature was 0.924 and 0.861 in the testing dataset, respectively. For the radiomics signature, the accuracy was 88.6%, with 88.0% specificity and 89.5% sensitivity. When combined, the AUC was 0.931, the specificity was 84.0%, and the sensitivity was 89.5%. The differences between the AUC values of the two sole models and the combination model were statistically nonsignificant. CONCLUSION Radiomics based on CT images can be helpful to differentiate benign and malignant gallbladder polyps ≥ 1 cm in size.
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Affiliation(s)
- Xiaodong Yang
- Department of Radiology, The First Affiliated Hospital of China Medical University, No.155 Nanjing Road Heping Area, Shenyang, 110000, Liaoning Province, China
| | - Yi Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, No.155 Nanjing Road Heping Area, Shenyang, 110000, Liaoning Province, China
| | - Yan Guo
- GE Health, Shanghai, 200000, China
| | - Ruimei Chai
- Department of Radiology, The First Affiliated Hospital of China Medical University, No.155 Nanjing Road Heping Area, Shenyang, 110000, Liaoning Province, China
| | - Meng Niu
- Department of Radiology, The First Affiliated Hospital of China Medical University, No.155 Nanjing Road Heping Area, Shenyang, 110000, Liaoning Province, China
| | - Ke Xu
- Department of Radiology, The First Affiliated Hospital of China Medical University, No.155 Nanjing Road Heping Area, Shenyang, 110000, Liaoning Province, China.
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Tanaka K, Katanuma A, Hayashi T, Kin T, Takahashi K. Role of endoscopic ultrasound for gallbladder disease. J Med Ultrason (2001) 2020; 48:187-198. [PMID: 32661803 PMCID: PMC8079297 DOI: 10.1007/s10396-020-01030-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
Endoscopic ultrasonography (EUS) has excellent spatial resolution and allows more detailed examination than abdominal ultrasonography (US) in terms of qualitative diagnosis of tumors and evaluation of tumor invasion depth. To understand the role of EUS in gallbladder disease, we need to understand the normal gallbladder wall structure and how to visualize it on EUS. In addition, gallbladder lesions can be classified into two broad categories: protuberant and wall-thickening lesions. Here, the features on EUS were outlined. We also outlined the current status of EUS-FNA for gallbladder lesions as there have been scattered reports of EUS-FNA in recent years.
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Affiliation(s)
- Kazunari Tanaka
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan.
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Kuniyuki Takahashi
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, 006-8555, Japan
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33
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Vascular evaluation using transabdominal ultrasound for gallbladder polyps. J Med Ultrason (2001) 2020; 48:159-173. [DOI: 10.1007/s10396-020-01008-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
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Pickering O, Pucher PH, Toale C, Hand F, Anand E, Cassidy S, McEntee G, Toh SKC. Prevalence and Sonographic Detection of Gallbladder Polyps in a Western European Population. J Surg Res 2020; 250:226-231. [PMID: 32106001 DOI: 10.1016/j.jss.2020.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/31/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gallbladder cancer is rare but associated with significant morbidity and mortality necessitating the early identification of premalignant and malignant lesions to improve overall prognosis. Despite limited evidence regarding the effectiveness of transabdominal ultrasound (US) in the detection of gallbladder polyps, it plays a key role in current European guidelines. The aim of this study was to investigate gallbladder polyp prevalence in a western European population and assess the diagnostic accuracy of transabdominal US. METHODS Data from patients who underwent cholecystectomy for US detected gallbladder polypoid lesions at four hospitals in Ireland and the United Kingdom between 2010 and 2018 were retrospectively collected. Patient demographics, ultrasonographic, and histopathologic findings were analyzed. RESULTS A total of 134 patients underwent cholecystectomy for US-detected gallbladder polyps. After histopathologic examination, pseudopolyps were found in 75 (56%) specimens with dysplastic or malignant polyps seen in only six (4.5%) specimens. Mean size for neoplastic polyps was 33 mm. The positive predictive value for US in detecting neoplastic polyps in this study was 4.5%, which is significantly lower than the 10%-15% reported previously. CONCLUSIONS Although the prevalence of neoplastic polyps in this study is higher than in the previous literature, the distribution of pseudopolyps and true polyps is as expected. With all malignant polyps being >10 mm in diameter, these findings support the current size thresholds stated in European guidelines. The poor diagnostic accuracy of US demonstrated may have led to significant number of patients undergoing unnecessary surgical intervention, further supporting the argument for improved strategies for the investigation of gallbladder polyps.
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Affiliation(s)
- Oliver Pickering
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom.
| | - Philip H Pucher
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom
| | - Conor Toale
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fiona Hand
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Easan Anand
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom
| | - Sheena Cassidy
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gerry McEntee
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Simon K C Toh
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom
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35
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Lee SB, Lee Y, Kim SJ, Yoon JH, Kim SH, Kim SJ, Jung HK, Hahn S, Baek HJ. Intraobserver and interobserver reliability in sonographic size measurements of gallbladder polyps. Eur Radiol 2020; 30:206-212. [PMID: 31399751 DOI: 10.1007/s00330-019-06385-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the intraobserver and interobserver reliability of gallbladder polyp measurements using transabdominal US and the factors that affect reliability. METHODS From November 2017 to February 2018, two radiologists measured the maximum diameter of 91 gallbladder polyps using transabdominal US. Intraobserver and interobserver agreement were determined using 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs). The effects of image settings, polyp location, and polyp size were evaluated by comparing ICCs using z tests. RESULTS The intraobserver agreement rates were 0.960 (95% confidence interval [CI], 0.939-0.973) for observer 1 and 0.962 (95% CI, 0.943-0.975) for observer 2. The ICCs between the two observers were 0.963 (95% CI, 0.926-0.979) for the first measurement and 0.973 (95% CI, 0.950-0.984) for the second measurement. The 95% limits of agreement on repeated measurements were 22.3-25.2% of the mean, and those between the two observers were 25.5-34.2% of the mean. ICCs for large polyps (≥ 5 mm) were significantly higher than those for small polyps (< 5 mm). There were no significant differences in the ICCs between image settings and polyp location. CONCLUSIONS Polyp size measurements using transabdominal US are highly repeatable and reproducible. Polyp size significantly affects the reliability of measurement. Diameter changes of approximately less than 25% may fall within the measurement error; this should be considered while interpreting the change in size during follow-up US, especially for small polyps. KEY POINTS • Gallbladder polyp size measurement using transabdominal US is highly repeatable and reproducible. • Diameter changes of approximately less than 25% should be interpreted carefully, especially in small polyps.
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Affiliation(s)
- Seul Bi Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea.,Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Yedaun Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea.
| | - Seung Jin Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea
| | - Jung Hee Yoon
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea
| | - Suk Jung Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea
| | - Hyun Kyung Jung
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Mohammed AA. Giant intracholecystic papillary tubular adenoma of the gall bladder with gall stones in an elderly woman; case report. Ann Med Surg (Lond) 2019; 47:13-15. [PMID: 31641494 PMCID: PMC6796548 DOI: 10.1016/j.amsu.2019.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/29/2019] [Accepted: 09/15/2019] [Indexed: 11/25/2022] Open
Abstract
Gall bladder polyps occur in 0.4% of patients undergoing cholecystectomy, the majority of gall bladder polyps are benign, they are classified into 3 types: epithelial or adenomatous polyps, mesenchymal polyps, and pseudopolyps. Gall bladder polys mostly affect females and those more than 50 years of age. Ultrasound is a very sensitive tool in the diagnosis. An 88-year-old woman presented with epigastric pain and right hypochondrial pain, fever, and vomiting for 1 week. Clinical examination showed jaundice and tenderness at the right hypochondrial region. Investigations showed elevated WBC, bilirubin level and the alkaline phosphatase. MRCP showed multiple gall stones with a large irregular polyp in the fundus of the gall bladder, and dilated common bile duct with multiple stones in the lumen of common bile duct. Cholecystectomy was done with exploration of the common bile duct with extraction of stones, T-tube was placed inside the CBD. At the 14th day T-tube cholangiography was done which showed passage of the dye to the duodenum, the tube was extracted and the patient was discharged home with no postoperative complications. The histopathology showed intracholecystic papillary tubular adenoma of the gall bladder with no evidence of malignancy. The general indications of surgery for gall bladder polyps include the size if more than 10 mm especially if solitary, the presence of associated gall stones, the age if more than 60 years, and if the polyps are causing symptoms. In this patients the large size of the polyp and obstructive jaundice were the two indications for surgery. Gall bladder polyps are commonly diagnosed and may be associated with gall stones. Most patients are worried about the possibility of malignancy. Laparoscopic cholecystectomy can be safely done when there is indication for surgery.
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Affiliation(s)
- Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.,Azadi Teaching Hospital, 8 Nakhoshkhana Road, 1014 AM, Duhok City, DUHOK, Kurdistan Region, Iraq
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Sakamoto K, Takai A, Ueno Y, Inoue H, Ogawa K, Takada Y. Scoring System to Predict pt2 in Gallbladder Cancer Based on Carcinoembryonic Antigen and Tumor Diameter. Scand J Surg 2019; 109:301-308. [PMID: 31354079 DOI: 10.1177/1457496919866016] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS T2 gallbladder cancer requires lymph node dissection for curative resection, whereas simple cholecystectomy is adequate to treat T1 gallbladder cancer. Hence, this study aimed to develop an accurate scoring system to preoperatively predict pT2 in gallbladder cancer. MATERIAL AND METHODS We retrospectively assessed data from 57 patients with suspected gallbladder cancer who underwent curative resection between September 2003 and May 2017. Six with apparent invasion of adjacent organs on preoperative images were excluded. We evaluated preoperative computed tomography, magnetic resonance and endoscopic ultrasonographic images, blood biochemistry, and the maximum standard uptake value in fluorodeoxyglucose-positron emission tomography images. We analyzed whether correlations between preoperative findings and the depth of tumor invasion could predict pT2. RESULTS The pathological diagnosis was gallbladder cancer in 30 (58.8%) patients, of whom 21 (69.9%) had pT2 or worse. Multivariate analyses selected carcinoembryonic antigen and tumor diameter as independent predictors of pT2 or worse (odds ratios = 1.741 and 1.098, respectively; 95% confidence intervals = 1.004-3.020 and 1.008-1.197, respectively). A regression formula was created using carcinoembryonic antigen and tumor diameter to calculate pT2 predictive scores. The area under the receiver operating characteristics curve of the pT2 predictive score was 0.873. CONCLUSION We created a scoring system to predict pT2 in gallbladder cancer using carcinoembryonic antigen and tumor diameter. The present findings suggested that carcinoembryonic antigen is important for the preoperative evaluation of gallbladder cancer.
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Affiliation(s)
- K Sakamoto
- Department of Surgery, Ehime University Hospital, Toon, Japan
| | - A Takai
- Department of Surgery, Ehime University Hospital, Toon, Japan
| | - Y Ueno
- Department of Surgery, Ehime University Hospital, Toon, Japan
| | - H Inoue
- Department of Surgery, Ehime University Hospital, Toon, Japan
| | - K Ogawa
- Department of Surgery, Ehime University Hospital, Toon, Japan
| | - Y Takada
- Department of Surgery, Ehime University Hospital, Toon, Japan
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Abstract
OBJECTIVE Unlike adults, gallbladder polyps (GPs) are rare in childhood. The aim of this study was to evaluate patients with a GP diagnosis. METHODS Patients who were diagnosed with GP via ultrasonography from October 2012 to October 2017 were retrospectively evaluated in terms of sociodemographic characteristics and laboratory findings. RESULTS The study included 19 patients diagnosed with GP and followed up in our department. The patients comprised 14 (73.6%) girls with a mean age of 13.9 ± 4.1 years and a mean follow-up period of 10.2 ± 5.4 months (range, 3-26 months). The most common presenting symptom of the patients (n = 15, 78.9%) for ultrasonography was abdominal pain without biliary symptoms. Location of the polyps was in the corpus in 55% of patients, and either in the fundus (20%) or the neck of the gallbladder (25%). The average diameter of the polyps was 4.5 ± 1.6 mm (range, 2-9 mm). Multiple polyps were observed in 3 patients. No significant change in the number or size of polyps was noted at the end of the follow-up periods. Cholecystectomy was applied to 1 patient who had >5 polyps with a rapid increase in size, and the pathology report was hamartomatous polyp. There was no remarkable change in the clinical or laboratory findings of other patients during the follow-up period. CONCLUSION In this study, GPs could be seen in young children as young as 16 months of age and ultrasonography is sufficient for follow-up in stable and asymptomatic patients.
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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: 25] [Impact Index Per Article: 5.0] [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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Corten BJGA, Alexander S, van Zwam PH, Leclercq WKG, Roumen RMH, Slooter GD. Outcome of Surgical Inspection of the Gallbladder in Relation to Final Pathology. J Gastrointest Surg 2019; 23:1130-1134. [PMID: 30132295 DOI: 10.1007/s11605-018-3921-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/06/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Routine histopathologic gallbladder examination after cholecystectomy has been a point of discussion. The aim of this study was to evaluate the macroscopic examination by the surgeon in relation to the final histology. METHODS A prospective study was conducted to investigate the practice of macroscopic gallbladder examination by a surgeon compared to routine histopathology by a pathologist. All consecutive cholecystectomies were included between November 2009 and February 2011. RESULTS A total of 319 consecutive cholecystectomies were performed. Of all macroscopic examinations, the surgeon identified 62 gallbladders with macroscopic abnormalities, ranging from polyps to wall thickening or ulcers. In 55 (17.2%) cases, the surgeon judged that further examination of the specimen by the pathologist could possibly lead to additional and relevant findings. There was a strong agreement between the surgeon and the pathologist concerning the macroscopic examination (κappa = 0.822). The surgeon and the pathologist had disagreement on the macroscopic examination of 18 gallbladders, without clinical consequences for the patient. DISCUSSION The present prospective study shows that the surgeon should be able to select those gallbladders needing a microscopic gallbladder examination. Potentially, about 80% of this kind of routine histology can be reduced.
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Affiliation(s)
- B J G A Corten
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.
| | - S Alexander
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - P H van Zwam
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, The Netherlands
| | - W K G Leclercq
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - R M H Roumen
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - G D Slooter
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
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Funamizu N, Nakabayashi Y. Cavernous Hemangioma of the Gallbladder Masquerading as a Carcinoma. Case Rep Gastroenterol 2019; 13:219-224. [PMID: 31123450 PMCID: PMC6515123 DOI: 10.1159/000500079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/02/2019] [Indexed: 12/04/2022] Open
Abstract
Cavernous hemangioma arising from the gallbladder is extremely rare. Here, we report a cavernous hemangioma of the gallbladder masquerading as a carcinoma. A 75-year-old man was referred to our institution for a follow-up study after gastrectomy. Abdominal computed tomography revealed that the gallbladder was filled with a low-density mass with calcification of the wall. The patient underwent extended cholecystectomy. Histologically, the tumor consisted of vascular endothelial cellular elements and hematomas. The postoperative course was uneventful without complications. Presently, only 7 cases of cavernous hemangioma of the gallbladder have been previously reported. This case serves as an important reminder to consider benign tumors including cavernous hemangioma when investigating all possible causes of a gallbladder tumor.
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Affiliation(s)
- Naotake Funamizu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
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Miwa H, Numata K, Sugimori K, Sanga K, Hirotani A, Tezuka S, Goda Y, Irie K, Ishii T, Kaneko T, Tanaka K, Maeda S. Differential diagnosis of gallbladder polypoid lesions using contrast-enhanced ultrasound. Abdom Radiol (NY) 2019; 44:1367-1378. [PMID: 30478647 DOI: 10.1007/s00261-018-1833-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of the study is to evaluate the utility of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of gallbladder polypoid lesions (GPLs). METHODS Thirty-six patients with GPLs (17 with gallbladder cancer, 19 with benign polyps) who underwent CEUS were enrolled in the study. The mean age of patients was 65.7 ± 12.6 years. Perflubutane-based contrast agent and high-mechanical index mode, which can eliminate the background B-mode and provide precise visualization of tumor vessels, were used for CEUS, and two blinded readers evaluated the images, retrospectively. RESULTS Patient age and size of malignant GPLs (72.4 ± 9.4 years and 23.4 ± 7.5 mm) were significantly greater than those for benign lesions (59.6 ± 12.3 years and 12.4 ± 2.9 mm) (P < 0.01, respectively), and the receiver operating characteristic analysis showed the cut-off value as over 65 years and 16 mm. Univariate analysis showed that heterogeneity in B-mode (80% [12/15]), sessile shape (76% [13/17]), dilated vessel (71% [12/17]), irregular vessel (82% [14/17]), and heterogeneous enhancement (59% [10/17]) on CEUS were significantly correlated with malignant GPLs (P < 0.01, respectively). On CEUS, the diagnostic criterion for malignant GPLs was defined as having one or more of the above four features because of the highest accuracy. Sensitivity, specificity, and accuracy for malignant GBLs were 88%, 68%, and 78% for patient age; 76%, 89%, and 83% for size of GPLs; 80%, 68%, and 74% for B-mode; and 94%, 89%, and 92% for CEUS, respectively. CONCLUSIONS CEUS is useful for the differential diagnosis of malignant and benign GPLs.
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Abdullah AAN, Rangaraj A, Rashid M, Puw-Jones R, Rasheed A. Gallbladder polypoid lesions are inaccurately reported and undermanaged: a retrospective study of the management of gallbladder polypoid lesions detected at ultrasound in symptomatic patients during a 36-month period. Clin Radiol 2019; 74:489.e17-489.e23. [PMID: 30910171 DOI: 10.1016/j.crad.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 02/06/2019] [Indexed: 01/11/2023]
Abstract
AIM To investigate whether gallbladder polypoid lesions (GPL) are accurately reported and managed by radiologists, sonographers, general practitioners (GPs) and surgeons. MATERIALS AND METHODS Consecutive abdominal ultrasound examinations indicating GPL in symptomatic patients performed during 2011-2013 were captured and analysed. The study comprised 244 patients who satisfied the inclusion criteria. RESULTS Of the ultrasound reports retrieved, 238/244 reports (98%) erroneously described the polypoid lesions as polyps. One hundred and thirty-two of the 244 (54%) reports recommended follow-up, 5/244 (2%) recommended no follow-up, 35/244 (14%) deemed the findings insignificant, and 72/244 (30%) did not comment. Regarding GP referral, 57/184 (31%) patients were correctly referred to general surgeons, 20/184 (11%) to gastroenterologists, and 107/184 (58%) were not referred to secondary care. Forty-three of the 244 patients (18%) underwent cholecystectomy. Regarding subsequent biliary presentations, 63/244 patients (26%) presented at a later date with biliary symptoms; 13/63 (21%) of these eventually had cholecystectomies with 2/13 (15%) experiencing potentially life-threatening pancreatitis episodes. Regarding the surgical approach, differences were observed in the way individual surgeons managed polypoid lesions, with some veering towards cholecystectomy, others towards follow-up ultrasound, and some towards discharge. CONCLUSION GPL tend to be misreported by radiologists and sonographers, unappreciated by GPs, and variably managed by surgeons. These factors delay definitive therapy and seem to contribute to future biliary presentations. A fresh educational approach is required to raise awareness among radiologists, sonographers, and GPs regarding the clinical relevance and possible representations of GPL, and a uniform strategy is needed for managing GPL.
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Affiliation(s)
- A A N Abdullah
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK.
| | - A Rangaraj
- Department of Radiology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - M Rashid
- Department of Histopathology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - R Puw-Jones
- Department of Histopathology, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - A Rasheed
- Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK
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Liu HW, Chen CY. Ovo-lactovegetarian diet as a possible protective factor against gallbladder polyps in Taiwan: A cross-sectional study. Tzu Chi Med J 2019; 31:29-34. [PMID: 30692829 PMCID: PMC6334569 DOI: 10.4103/tcmj.tcmj_16_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective Gallbladder polyps (GBPs) are an increasingly common incidental finding and 3% to 8% of GBPs become malignant. A poor prognosis is expected in patients with gallbladder cancer. No studies have considered the relationship between diet and the development of GBPs in the Taiwanese population. The objective of this study was to investigate whether a vegetarian diet protects against GBP development. Materials and Methods This cross-sectional study included 11,717 individuals who received a health checkup at Taipei Tzu Chi Hospital (New Taipei City, Taiwan) between October 2011 and October 2016. All individuals completed questionnaires that collected data about their characteristics, dietary patterns, and lifestyle. Physical examinations were conducted, and blood chemistry tests were performed. The presence of GBPs was determined using ultrasonography. We subsequently evaluated the association between diet and GBP prevalence using multivariate analysis. Results The prevalence of GBPs for the entire group was 8.3%. GBPs were significantly less common in the vegetarian groups (vegans 9.0%, ovo-lacto vegetarians 7.5%, and semi-vegetarians 7.2%) compared with the omnivore group (9.6%) (P = 0.002). Step-wise logistic regression revealed that an ovo-lacto vegetarian diet was a possible protective factor (odds ratio = 0.83, P = 0.015). Conclusions The study findings showed a strong negative association between an ovo-lacto vegetarian diet and GBP occurrence.
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Affiliation(s)
- Hao-Wen Liu
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Cheng-Yu Chen
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
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Abstract
INTRODUCTION Gallbladder polyps (GBPs) are generally harmless, but the planning of diagnosis and treatment of the GBP is of clinical importance due to the high mortality risk of delays in the diagnosis of gallbladder carcinomas that show polypoid development. MATERIALS AND METHODS GBPs are usually incidentally detected during ultrasonographic (USG) examinations of the abdomen. The risk of carcinoma development from polypoid lesions in the literature is reported as 0-27%. There is no consensus about the management of the GBPs. Herein, we reviewed the contemporary data to update our knowledge about diagnosis and treatment of gallbladder polyps. RESULTS Polyps can be identified in five different groups, primarily as neoplastic and non-neoplastic. Cholesterol polyps account for 60% of all cases. The most common (25%) benign polypoid lesions after cholesterol polyps are adenomyomas. CONCLUSION Ultrasonography and endoscopic ultrasonography seems to be the most important tool in differential diagnosis and treatment. Ultrasonography should be repeated in every 3-12 months in cases that are thought to be risky. Nowadays, the most common treatment approach is to perform cholecystectomy in patients with polyps larger than 10 mm in diameter. Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy. HOW TO CITE THIS ARTICLE Dilek ON, Karsu S, et al. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol 2019;9(1):40-48.
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Affiliation(s)
- Osman Nuri Dilek
- Department of Surgery, Izmir Katip Çelebi University School of Medicine, Izmir, Turkey
| | - Sebnem Karasu
- Department of Radiology, Izmir Katip Çelebi University School of Medicine, Izmir, Turkey
| | - Fatma Hüsniye Dilek
- Department of Pathology, Izmir Katip Çelebi University School of Medicine, Izmir, Turkey
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Metabolic status and lifestyle factors associated with gallbladder polyps: a covariance structure analysis. BMC Gastroenterol 2018; 18:159. [PMID: 30382815 PMCID: PMC6211420 DOI: 10.1186/s12876-018-0882-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
Background Gallbladder Polyps (GBP) are highly prevalent in China; however, the etiology of GBP has not been clearly defined. This study explored the associations between lifestyle factors and GBP and whether it mediated by metabolic factors or not. Methods A total of 487 newly diagnosed GBP cases and 502 healthy controls were involved in this study. A questionnaire was used to investigate the socio-demographic characteristics and lifestyle factors. Food Intake Frequencies Questionnaire was used to obtain the food intake frequencies of seven food categories. Blood was tested for lipid profiles, fasting blood glucose and blood urine acid. A Covariance Structure Analysis was used in the analysis to explore the possible pathways between socio-demographic characteristics, lifestyle factors, metabolic factor and GBP. Results The Covariance Structure Analysis showed that a higher BMI and elevated triglyceride level mediated the association between age and GBP. Lifestyle factors (smoking and drinking) and higher intake frequencies of fatty food (meat and viscera) also linked to higher BMI and higher triglyceride level, respectively, which were associated with GBP. Conclusion In conclusion, age and lifestyle factors might be indirectly related with GBP through BMI and the triglyceride pathway.
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Oh SH, Han HY, Kim HJ. Comet tail artifact on ultrasonography: is it a reliable finding of benign gallbladder diseases? Ultrasonography 2018; 38:221-230. [PMID: 30481951 PMCID: PMC6595125 DOI: 10.14366/usg.18029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/03/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to evaluate whether the comet tail artifact on ultrasonography can be used to reliably diagnose benign gallbladder diseases. Methods This retrospective study reviewed the clinical findings, imaging findings, preoperative ultrasonographic diagnoses, and pathological diagnoses of 150 patients with comet tail artifacts who underwent laparoscopic cholecystectomy with pathologic confirmation. The extent of the involved lesion was classified as localized or diffuse, depending on the degree of involvement and the anatomical section of the gallbladder that was involved. This study evaluated the differences in clinical and imaging findings among pathologic diagnoses. Results All gallbladder lesions exhibiting the comet tail artifact on ultrasound examination were confirmed as benign gallbladder diseases after cholecystectomy, including 71 cases of adenomyomatosis (47.3%), 74 cases of chronic cholecystitis (49.3%), two cases of xanthogranulomatous cholecystitis (1.3%), and three cases of cholesterolosis (2.0%); there were two cases of coexistent chronic cholecystitis and low-grade dysplasia. There were no statistically significant differences in any of the clinical and ultrasonographic findings, with the exception of gallstones (P=0.007), among the four diseases. There were no significant differences in the average length, thickness, or number of comet tail artifacts among the four diagnoses. No malignancies were detected in any of the 150 thickened gallbladder lesions. Conclusion The ultrasonographic finding of the comet tail artifact in patients with thickened gallbladder lesions is associated with the presence of benign gallbladder diseases, and can be considered a reliable sign of benign gallbladder disease.
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Affiliation(s)
- Sung Hoon Oh
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Hyun Young Han
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Hee Jin Kim
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
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Abstract
The finding of gallbladder polyps on imaging studies prompts further workup. Imaging results are often discordant with final pathology. The goal of this study is to compare polypoid lesions of the gallbladder found on preoperative ultrasound (US) with final pathologic diagnosis after cholecystectomy to help guide clinical decision-making. A retrospective study was conducted identifying adult patients who were diagnosed with polyps via US and who underwent cholecystectomy from 2008 through 2015. Imaging data, final pathology, and demographics were manually reviewed. A total of 2290 cholecystectomy patients had US-based polyps. Of these, 1661 patients (73%) did not have polyps on final pathology; primarily, stones or sludge were identified. Adenomyosis was diagnosed in 61 patients (2.7%). A total of 556 patients (24.2%) had pathologic polypoid lesions with the following breakdown: 463 (20.2%) cholesterol polyps, 43 other benign polyps (1.8%), 40 adenomas (1.7%), and 10 adenocarcinomas (0.4%). All patients with adenocarcinoma were older than 40 years and 91 per cent had US findings of polyps >10 mm. Ultrasound alone is an unreliable method of detecting real gallbladder polyps. This large database study found a very low risk of cancer. Size on US and patient age should be considered in the selection of appropriate surgical candidates with sonographic “polyps.”
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Affiliation(s)
- Yiping Li
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Talar Tejirian
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - J. Craig Collins
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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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: 39] [Impact Index Per Article: 6.5] [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. 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: 4.5] [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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