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Marcinak CT, Abbott DE. Gallbladder Cancer. Cancer Treat Res 2024; 192:147-163. [PMID: 39212920 DOI: 10.1007/978-3-031-61238-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Gallbladder carcinoma (GBC) is the most common biliary epithelial malignancy, with an estimated incidence of 1.13 cases per 100,000 in the United States (Hundal and Shaffer in Clin Epidemiol 6:99-109, 2014 1; Henley et al. in Cancer Epidemiol Biomarkers Prev 24:1319-1326, 2015 2). The insidious nature and late presentation of this disease place it among the most lethal invasive neoplasms. Gallbladder cancer spreads early by lymphatic or hematogenous metastasis, as well as by direct invasion into the liver. While surgery may be curative at early stages, both surgical and nonsurgical treatments remain largely unsuccessful in patients with more advanced diseases (Rahman et al. in Cancer Med 6:874-880, 2017 3).
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Affiliation(s)
- Clayton T Marcinak
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin-Madison, 7375 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin-Madison, 7375 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA.
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2
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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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Kamaya A, Fung C, Szpakowski JL, Fetzer DT, Walsh AJ, Alimi Y, Bingham DB, Corwin MT, Dahiya N, Gabriel H, Park WG, Porembka MR, Rodgers SK, Tublin ME, Yuan X, Zhang Y, Middleton WD. Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2022; 305:277-289. [PMID: 35787200 DOI: 10.1148/radiol.213079] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.
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Affiliation(s)
- Aya Kamaya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Christopher Fung
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Jean-Luc Szpakowski
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David T Fetzer
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Andrew J Walsh
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yewande Alimi
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David B Bingham
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Michael T Corwin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Helena Gabriel
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Walter G Park
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Matthew R Porembka
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Shuchi K Rodgers
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Mitchell E Tublin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Xin Yuan
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yang Zhang
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - William D Middleton
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
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Candia R, Viñuela M, Chahuan J, Diaz LA, Gándara V, Errázuriz P, Bustamante L, Villalon A, Huete Á, Crovari F, Briceño E. Follow-up of gallbladder polyps in a high-risk population of gallbladder cancer: a cohort study and multivariate survival competing risk analysis. HPB (Oxford) 2022; 24:1019-1025. [PMID: 34895828 DOI: 10.1016/j.hpb.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/29/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The risk of neoplasia in gallbladder polyps seems to be low, but the evidence from populations at high-risk of gallbladder cancer is limited. We aimed to estimate the risk and to identify the factors associated with neoplastic polyps in a high-risk Hispanic population. METHODS A retrospective cohort was recruited between January 2010 and December 2019 at a Chilean university center. Multivariate survival analyses were conducted. Fine-Gray models were fitted to account for competing risks. Covariate adjustment was conducted using propensity scores. The main outcome was the development of gallbladder adenomas or adenocarcinoma. RESULTS Overall, 748 patients were included, 59.6% underwent cholecystectomy. The median follow-up of patients not subjected to cholecystectomy was 54.7 months (12-128.6 months). Seventeen patients (2.27%) developed the outcome. After adjustment by age, sex, intralesional blood flow, lithiasis and gallbladder wall thickening, only polyp size (≥10 mm, adjusted-HR: 15.01, 95%CI: 5.4-48.2) and number of polyps (≥3 polyps, adjusted-HR: 0.11, 95%CI: 0.01-0.55) were associated with neoplasia. CONCLUSION In a Hispanic population at high-risk for gallbladder cancer, gallbladder polyps seem to have a low risk of neoplasia. Polyp size was the main risk factor, while having multiple polyps was associated with an underlying benign condition.
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Affiliation(s)
- Roberto Candia
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.
| | - Macarena Viñuela
- Alumnos de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Javier Chahuan
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Luis A Diaz
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Vicente Gándara
- Alumnos de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Pedro Errázuriz
- Alumnos de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Luis Bustamante
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Alejandro Villalon
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Álvaro Huete
- Departamento de Radiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Fernando Crovari
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Eduardo Briceño
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.
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6
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Yankov I, Boyanov N, Aleksova L, Ivanov B, Moshekov E, Chatalbashev D, Stefanova P. Gallbladder polyp in children - a rare finding during ultrasound examination. J Ultrason 2022; 22:e64-e66. [PMID: 35449699 PMCID: PMC9009351 DOI: 10.15557/jou.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/01/2021] [Indexed: 12/02/2022] Open
Abstract
Gallbladder polyps are a relatively rare finding in children. The increased use of high-resolution ultrasound in childhood allows to detect gallbladder lesions in young patients. A precise diagnosis can be established using different imaging series. Abdominal contrast-enhanced ultrasound examination provides the most accurate imaging information about the nature and size of the lesion. This is important for further decisions regarding patient referral for cholecystectomy. The object of this study was to present a case of gallbladder polyp diagnosed and followed up by contrast-enhanced ultrasound.
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Affiliation(s)
- Ivan Yankov
- Department of Pediatrics and Medical Genetics, Medical University of Plovdiv, Bulgaria.,Department of Pediatric Gastroenterology, University Hospital "St. George", Plovdiv, Bulgaria
| | - Nikola Boyanov
- Second Department of Surgical Diseases, University Hospital "St. George", Plovdiv, Bulgaria
| | - Lyubka Aleksova
- Department of Pediatric Surgery, University Hospital "St. George", Plovdiv, Bulgaria
| | - Biser Ivanov
- Department of Pediatric Surgery, University Hospital "St. George", Plovdiv, Bulgaria
| | - Evgeniy Moshekov
- Department of Pediatric Surgery, University Hospital "St. George", Plovdiv, Bulgaria
| | - Dimitar Chatalbashev
- Department of Pediatric Gastroenterology, University Hospital "St. George", Plovdiv, Bulgaria
| | - Penka Stefanova
- Department of Pediatric Surgery, University Hospital "St. George", Plovdiv, Bulgaria
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7
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Longitudinal Ultrasound Assessment of Changes in Size and Number of Incidentally Detected Gallbladder Polyps. AJR Am J Roentgenol 2022; 218:472-483. [PMID: 34549608 DOI: 10.2214/ajr.21.26614] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND. Previous European multisociety guidelines recommend routine follow-up imaging of gallbladder polyps (including polyps < 6 mm in patients without risk factors) and cholecystectomy for polyp size changes of 2 mm or more. OBJECTIVE. The purpose of this study was to assess longitudinal changes in the number and size of gallbladder polyps on serial ultrasound examinations. METHODS. This retrospective study included patients who underwent at least one ultrasound examination between January 1, 2010, and December 31, 2020 (as part of a hepatocellular carcinoma screening and surveillance program) that showed a gallbladder polyp. Number of polyps and size of largest polyp were recorded based primarily on review of examination reports. Longitudinal changes on serial examinations were summarized. Pathologic findings from cholecystectomy were reviewed. RESULTS. Among 9683 patients, 759 (8%) had at least one ultrasound examination showing a polyp. Of these, 434 patients (248 men, 186 women; mean age, 50.6 years) had multiple examinations (range, 2-19 examinations; mean, 4.8 examinations per patient; mean interval between first and last examinations, 3.6 ± 3.1 [SD] years; maximum interval, 11.0 years). Among these 434 patients, 257 had one polyp, 40 had two polyps, and 137 had more than two polyps. Polyp size was 6 mm or less in 368 patients, 7-9 mm in 52 patients, and 10 mm or more in 14 patients. Number of polyps increased in 9% of patients, decreased in 14%, both increased and decreased on serial examinations in 22%, and showed no change in 55%. Polyp size increased in 10% of patients, decreased in 16%, both increased and decreased on serial examinations in 18%, and showed no change in 56%. In 9% of patients, gallbladder polyps were not detected on follow-up imaging; in 6% of patients, gallbladder polyps were not detected on a follow-up examination but were then detected on later studies. No gallbladder carcinoma was identified in 19 patients who underwent cholecystectomy. CONCLUSION. Gallbladder polyps fluctuate in size, number, and visibility over serial examinations. Using a 2-mm threshold for growth, 10% increased in size. No carcinoma was identified. CLINICAL IMPACT. European multisociety guidelines that propose surveillance of essentially all polyps and a 2-mm size change as the basis for cholecystectomy are likely too conservative for clinical application.
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8
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Bao W, Xu A, Ni S, Wang B, Urmi H, Zhao B, You Y, Hu H. Is there a role for growth status in distinguishing gallbladder adenomas from cholesterol polyps? - A retrospective study based on 520 cholecystectomy patients. Scand J Gastroenterol 2021; 56:1450-1455. [PMID: 34461797 DOI: 10.1080/00365521.2021.1970220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Gallbladder adenomas have cancerous potential and occur in 4-8.9% of gallbladder polyps. The growth status (size progression and growth rate during follow-up) of polyps and their effectiveness for predicting adenomas are poorly defined. Herein, we compared adenomas and cholesterol polyps based on the growth status and evaluated the reported risk factors in predicting neoplasm. METHODS We enrolled 520 patients who underwent preoperative ultrasonic follow-up more than 6 months with post-cholecystectomy pathologically confirmed gallbladder polyps. The patients were classified into adenoma and cholesterol polyp groups. Growth status, clinical characteristics, laboratory data, ultrasonic findings were reviewed and compared between the groups. RESULTS Seventy-nine adenomas and 441 cholesterol polyps were analyzed. The mean diameter of adenomas (cholesterol polyps) was 7.24 ± 4.36 mm (6.23 ± 2.88 mm) in the initial and 12.06 ± 4.61 mm (10.05 ± 2.95 mm) in the preoperative examination. The median size progression (range) of polyps in the cholesterol polyps [3 (0, 22)] mm was smaller than that in adenomas [4 (0, 21)] mm (p = .075). The mean growth rate of adenomas (1.07 ± 1.33 mm/6 months) was slightly faster than in cholesterol polyps (0.83 ± 1.04 mm/6 months) (p = .338). The indicators significantly associated with adenomas were age >49.5 years, lack of gallbladder polyps/cholelithiasis family history, polyp size >11.5 mm and solitary polyp (p = .005, p = .027, p = .001, and p = .021, respectively). CONCLUSION Growth status was not a valuable modality to distinguishing gallbladder adenomas from cholesterol polyps. Risk factors such as age, polyp size, and solitary polyp were effective in predicting adenomas.
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Affiliation(s)
- Wenqing Bao
- Tongji University School of Medicine, Gallbladder Diseases Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Anan Xu
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Shubin Ni
- Department of General Surgery, Shanghai Seventh People's Hospital, Shanghai, China
| | - Bo Wang
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Humaira Urmi
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Bin Zhao
- Department of General Surgery, Shanghai Seventh People's Hospital, Shanghai, China
| | - Yongmei You
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
| | - Hai Hu
- Gallbladder Disease Center, Tongji University Affiliated Shanghai East Hospital, Shanghai, China
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9
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Ostapenko A, Liechty S, Kim M, Kleiner D. Accuracy of Ultrasound in Diagnosing Gallbladder Polyps at a Community Hospital. JSLS 2021; 24:JSLS.2020.00052. [PMID: 33100819 PMCID: PMC7572097 DOI: 10.4293/jsls.2020.00052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background and Objectives: Polyps are reported on 1–10% of routine transabdominal ultrasound studies of the gallbladder. Prior studies have reported poor sensitivity and specificity for this diagnostic modality at determining malignant potential of polyps. The aim of this study is to determine the incidence of gallbladder polyps documented on ultrasound at a community hospital, evaluate the congruency of ultrasound with final histopathology, and explore factors which may improve ultrasound accuracy at diagnosing true adenomatous polyps. Methods: We conducted a 5-year retrospective cohort study of patients undergoing cholecystectomy at Danbury Hospital between 2014 and 2019, identifying those with a pre-operative ultrasound mention of a “polyp” or “mass.” We assessed the congruency of ultrasound findings with pathology reports. Results: Of the 2,549 cholecystectomies performed, 1,944 (76%) had pre-operative ultrasounds. Of those, 98 (5.0%) reported a polyp, measuring an average of 8.1 mm (SD 7.1 mm). Three (3.1%) specimens were identified as adenomas on final histopathology; the majority were benign pathologies including cholesterol polyp (18), cholesterolosis (20), adenomyoma (4), adenomyomatosis (7), and chronic or acute cholecystitis (44). Interestingly, only 1 of the 3 adenomas measured > 10 mm on ultrasound, the accepted indication for surgical resection. Conclusions: The accuracy of transabdominal ultrasound in diagnosing true polyps is poor, with only 3% of polyps identified as adenomas based on pathology. Surgeons should use caution when making clinical decisions based on polyps identified on ultrasound, and more stringent diagnostic criteria are needed in order to decrease the false positive rate for diagnosis and screening.
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Affiliation(s)
| | - Shawn Liechty
- Department of General Surgery, Danbury Hospital, Danbury CT
| | - Minha Kim
- Department of General Surgery, Danbury Hospital, Danbury CT
| | - Daniel Kleiner
- Department of General Surgery, Danbury Hospital, Danbury CT
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10
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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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11
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Abstract
Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.
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12
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Onuchina EV. [Gallbladder polyps: modern approaches to diagnostics and treatment]. TERAPEVT ARKH 2021; 93:100-107. [PMID: 33720634 DOI: 10.26442/00403660.2021.01.200544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, benign tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.
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Affiliation(s)
- E V Onuchina
- Irkutsk State Academy of Postgraduate Education - a branch of the Russian Medical Academy of Continuous Professional Education
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13
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Analysis of risk factors for gallbladder polyp formation - A retrospective study based on serial ultrasounds. Eur J Gastroenterol Hepatol 2020; 32:1154-1159. [PMID: 32541237 DOI: 10.1097/meg.0000000000001814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To evaluate gallbladder polyp (GBP) formation related risk factors based on serial ultrasounds (US). METHODS Risk factors related GBP formation were retrospectively investigated among participants, who had US reexamination and interval >180 days in 5 years. After groups were divided based on US, we compared final data and initial data in GBP new incidence group. Then compared the data in GBP new incidence group and GBP(-) group. RESULTS Overall 20 447 participants were recruited, including 18 243 in GBP (-) group and 2204 in GBP group. The mean diameters of polyps were 0.455 ± 0.198 mm in initial and 0.420 ± 0.180 mm in final examination. GBP new incidence group included 797 participants. Percentage of GBP new incidence participants was higher than GBP resolved (36.16% vs. 11.71%). Participants in middle age were more likely have GBP size increase or new incidence, and participants in old age (≥60 years old) were with GBP size decrease or resolved. In GBP new incidence group, participants in final US showed higher FBG, higher LDL, lower HDL, higher ALT and higher AST than initial US. Compared with GBP (-) group and, same risk factors, in addition with age, were shown in GBP new incidence group, Logistic regression analysis show that higher LDL, lower HDL and higher AST were risk factors for GBP formation. CONCLUSION Participants in middle age were more likely to have GBP new incidence. Higher LDL, lower HDL and higher AST were independently risk factors for GBP formation.
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14
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Jeong Y, Kim JH, Chae HD, Park SJ, Bae JS, Joo I, Han JK. Deep learning-based decision support system for the diagnosis of neoplastic gallbladder polyps on ultrasonography: Preliminary results. Sci Rep 2020; 10:7700. [PMID: 32382062 PMCID: PMC7205977 DOI: 10.1038/s41598-020-64205-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/06/2020] [Indexed: 11/09/2022] Open
Abstract
Ultrasonography (US) has been considered image of choice for gallbladder (GB) polyp, however, it had limitations in differentiating between nonneoplastic polyps and neoplastic polyps. We developed and investigated the usefulness of a deep learning-based decision support system (DL-DSS) for the differential diagnosis of GB polyps on US. We retrospectively collected 535 patients, and they were divided into the development dataset (n = 437) and test dataset (n = 98). The binary classification convolutional neural network model was developed by transfer learning. Using the test dataset, three radiologists with different experience levels retrospectively graded the possibility of a neoplastic polyp using a 5-point confidence scale. The reviewers were requested to re-evaluate their grades using the DL-DSS assistant. The areas under the curve (AUCs) of three reviewers were 0.94, 0.78, and 0.87. The DL-DSS alone showed an AUC of 0.92. With the DL-DSS assistant, the AUCs of the reviewer’s improved to 0.95, 0.91, and 0.91. Also, the specificity of the reviewers was improved (65.1–85.7 to 71.4–93.7). The intraclass correlation coefficient (ICC) improved from 0.87 to 0.93. In conclusion, DL-DSS could be used as an assistant tool to decrease the gap between reviewers and to reduce the false positive rate.
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Affiliation(s)
- Younbeom Jeong
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Hee-Dong Chae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Sae-Jin Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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15
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Metman MJH, Olthof PB, van der Wal JBC, van Gulik TM, Roos D, Dekker JWT. Clinical relevance of gallbladder polyps; is cholecystectomy always necessary? HPB (Oxford) 2020; 22:506-510. [PMID: 31481314 DOI: 10.1016/j.hpb.2019.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder polyps are common incidental findings during abdominal ultrasonography. Cholecystectomy is recommended for polyps equal or greater than 10 mm on ultrasound due to their malignant potential. However, the majority of lesions appear to be pseudopolyps with no malignant potential. Our aim was to determine the correlation between ultrasonographic findings and histopathological findings after cholecystectomy for gallbladder polyps in two institutions. METHOD A retrospective analysis was performed at two Dutch institutions of patients who underwent cholecystectomy. All cholecystectomies for suspected gallbladder polyps between January 2010 and August 2017 were included. Ultrasonographic and histopathological reports were analyzed. RESULTS A total of 108 patients underwent cholecystectomy for gallbladder polyps. At abdominal ultrasound sixty-five patients (60.2%) were diagnosed with multiple gallbladder polyps. The mean diameter of the polyps was 11 mm. On pathological examination after cholecystectomy, only three specimens harbored true polyps. No anomalies were found in 48 (44%) patients and 51 (47%) had cholesterolosis. CONCLUSION The prevalence of true gallbladder polyps was much lower in this study than reported in literature. After cholecystectomy for gallbladder polyps diagnosed by ultrasound, 97% of patients had non-neoplastic or not identifiable lesions in the gallbladder. These findings question the usefulness of current guidelines for management of suspected gallbladder polyps.
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Affiliation(s)
- Madelon J H Metman
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.
| | - Pim B Olthof
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands; Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
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16
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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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Lodhi A, Waite K, Alam I. The accuracy of ultrasonography for diagnosis of gallbladder polyps. Radiography (Lond) 2020; 26:e52-e55. [PMID: 32052774 DOI: 10.1016/j.radi.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gallbladder polyps (GBPs) are gallbladder lesions which can progress to gallbladder malignancy. The incidence has been estimated as high as 12.1% of all cholecystectomy patients. Gallbladder malignancy typically presents late, and therefore carries a poor prognosis. By identifying potential GBPs early, it would be possible to treat polyps before they undergo malignant change. The current gold standard for GBP identification is with histological examination which is performed after cholecystectomy. This study sought to assess whether radiological imaging could reliably identify GBPs and therefore guide management. METHODS 1000 consecutive patients already undergoing cholecystectomy were sampled from two UK hospitals. Patients who underwent ultrasonography and had histological analysis of their gallbladders were selected. Overall 905 patients were included in the study. RESULTS There were 12 histologically confirmed GBPs in the cohort (1.33%). US correctly detected 1 GBP, with a sensitivity of 8.3% (95% CI 0.2-38.5%) and specificity of 96.0% (95% CI 94.5-97.2%). The overall accuracy was 94.8 (95% CI 93.2-96.2%). CONCLUSION These data show that US is an ineffective tool for GBP identification. The lack of prior operator exposure, imprecise nature of US and possible obstruction of images from underlying gallstone disease delivered a high rate of false positives. IMPLICATIONS FOR PRACTICE Surgical or oncological decisions regarding GBPs should not be based upon US findings alone as this would lead to unnecessary interventions. MRI should be investigated as an alternative imaging modality for GBP identification, as its differentiation of soft tissues could guide surgical management.
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Affiliation(s)
- A Lodhi
- Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK.
| | - K Waite
- Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK
| | - I Alam
- Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK
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18
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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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Yamin Z, Xuesong B, Guibin Y, Liwei L, Fei L. Risk factors of gallbladder polyps formation in East Asian population: A meta-analysis and systematic review. Asian J Surg 2019; 43:52-59. [PMID: 31109764 DOI: 10.1016/j.asjsur.2019.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/21/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023] Open
Abstract
To perform Meta-analysis to identify risk factors associated with gallbladder polyps (GBP) formation in east Asian population. Three English electronic bibliographic databases includes PubMed, Embase and Medline, with reviewed researches from 1986 to 2017. All possible risk factors of GBP formation were recorded. Meta-analyses were performed by Review Manager Software. Pooled odds ratios (OR) or the mean difference (MD) were used to determine risk factors. Sixteen studies and 227021 people were recruited, including 17261 people with GBP and 209760 without GBP. For categorical variables evaluated by OR test., risk factors of GBP formation were male gender (OR, 1.63; 95%CI, 1.42-1.87) and positive HBsAg. GBP formation were not correlated with age <50 years old, hypertension, DM, BMI ≥ 25kg/m2, smoking, drinking, HDL decrease, TC increase, TG increase, fatty liver and GBS. For continuous variables evaluated by MD test, risk factors of GBP formation were DBP (MD, 1.08; 95%CI, 0.15-2.02), mean BMI (MD,0.19; 95%CI,0.02-0.35), waist circumference (MD,1.780; 95%CI, 0.17,3.40), mean LDL (MD,0.89; 95%CI,0.03-1.75), mean HDL (MD,-1.87; 95%CI,-3.21 to -0.52). GBP formation were not correlated with mean age, SBP, mean TC, mean TG, ASL and ALT. In conclusion, risk factors of gallbladder polyp formation included male gender, higher BMI, higher waist circumference, higher DBP, higher LDL, lower HDL and positive HBsAg in east Asian population. GBP formation was not correlated with age, hypertension, DM, smoking, drinking, fatty liver, GBS, TC, TG, SBP, ASL and ALT. The mechanism of Dyslipidemias causing GBP needs deeper study in future.
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Affiliation(s)
- Zheng Yamin
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Bai Xuesong
- Xuanwu Hospital, The First Clinical Medical College, Capital Medical University, Beijing, China
| | - Yao Guibin
- Xuanwu Hospital, The First Clinical Medical College, Capital Medical University, Beijing, China
| | - Liu Liwei
- Xuanwu Hospital, The First Clinical Medical College, Capital Medical University, Beijing, China
| | - Li Fei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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20
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Heitz L, Kratzer W, Gräter T, Schmidberger J. Gallbladder polyps - a follow-up study after 11 years. BMC Gastroenterol 2019; 19:42. [PMID: 30885181 PMCID: PMC6423886 DOI: 10.1186/s12876-019-0959-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/07/2019] [Indexed: 12/16/2022] Open
Abstract
Background The aim of our study was to investigate the prevalence and natural long-term progression of gallbladder polyps in a random sample of the general population. Methods Four hundred and thirteen subjects (190 women, 223 men; aged 29–75 years) were studied first in 2002 and again eleven years later in 2013. All subjects were interviewed using a standardised questionnaire, anthropometric data were recorded, and an abdominal ultrasound scan was carried out. Results The prevalence of gallbladder polyps was 6.1% (115/1880) in the 2002 study and 12.1% (50/413) in the 2013 follow-up study. After eleven years, 36 subjects (8.7%, 36/413) had developed new polyps, thirteen subjects (48.1%, 13/27) no longer had gallbladder polyps, and 14 subjects (51.9%, 14/27) still had polyps. The number of polyps had increased in six of these subjects (43%, 6/14), decreased in a further six (43%, 6/14), and remained unchanged in two (14%, 2/14). The mean polyp size was 4.7 mm (± 2.2 mm, range 2–20 mm) in 2002 and 4.0 mm (± 1.9 mm, range 0.5–11 mm) at follow-up. A decrease in polyp size was noted in seven (50%) of the 14 subjects, an increase in size in five subjects (35.7%), and no change in two subjects (14.3%). The shape of the polyps had changed from pedunculated to sessile in two subjects (14.3%, 2/14) and from sessile to pedunculated in one subject (7.1%, 1/14). Conclusions In long-term follow-up, the prevalence of gallbladder polyps increased, with new lesions developing in 8.7% of the population. Polyps persisted in 51.9% of the subjects who had them in the original study and disappeared in the other 48.1%.
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Affiliation(s)
- Linda Heitz
- Centre for Internal Medicine, Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Centre for Internal Medicine, Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Tilmann Gräter
- Department of Diagnostic and Interventional Radiology, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Julian Schmidberger
- Centre for Internal Medicine, Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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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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22
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Martin E, Gill R, Debru E. Diagnostic accuracy of transabdominal ultrasonography for gallbladder polyps: systematic review. Can J Surg 2018; 61:200-207. [PMID: 29806818 PMCID: PMC5973908 DOI: 10.1503/cjs.011617] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous research has shown variable but generally poor accuracy of transabdominal ultrasonography in the diagnosis of gallbladder polyps. We performed a systematic review of the literature with the aim of helping surgeons interpret and apply these findings in the preoperative assessment and counselling of their patients. METHODS We searched PubMed, MEDLINE and the Cochrane database using the keywords "gallbladder," "polyp," "ultrasound," "pathology" and "diagnosis" for English-language articles published after 1990 with the full-text article available through our institutional subscriptions. Polyps were defined as immobile features that on transabdominal ultrasonography appear to arise from the mucosa and that lack an acoustic shadow, and pseudopolyps were defined as features such as inflammation, hyperplasia, cholesterolosis and adenomyomatosis that convey no risk of malignant transformation. RESULTS The search returned 1816 articles, which were narrowed down to 14 primary sources involving 15 497 (range 23-13 703) patients who had preoperative transabdominal ultrasonography, underwent cholecystectomy and had postoperative pathology results available. Among the 1259 patients in whom a gallbladder polyp was diagnosed on ultrasonography, 188 polyps were confirmed as true polyps on pathologic examination, and 81 of these were found to be malignant. Of the 14 238 patients for whom a polyp was not seen on ultrasonography, 38 had a true polyp on pathologic examination, none of which were malignant. For true gallbladder polyps, transabdominal ultrasonography had a sensitivity of 83.1%, specificity of 96.3%, positive predictive value of 14.9% (7.0% for malignant polyps) and negative predictive value of 99.7%. CONCLUSION Transabdominal ultrasonography has a high false-positive rate (85.1%) for the diagnosis of gallbladder polyps. Further study of alternative imaging modalities and reevaluation of existing management guidelines are warranted.
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Affiliation(s)
- Erin Martin
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - Richdeep Gill
- From the Department of Surgery, University of Calgary, Calgary, Alta
| | - Estifanos Debru
- From the Department of Surgery, University of Calgary, Calgary, Alta
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Bargellini P, Orlandi R, Paloni C, Rubini G, Fonti P, Righi C, Peterson ME, Rishniw M, Boiti C. Contrast-enhanced ultrasound complements two-dimensional ultrasonography in diagnosing gallbladder diseases in dogs. Vet Radiol Ultrasound 2018; 59:345-356. [DOI: 10.1111/vru.12601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 11/02/2017] [Accepted: 11/16/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
| | | | | | | | - Paolo Fonti
- Centro Veterinario Specialistico; 00137 Roma Italy
| | - Cecilia Righi
- Dipartimento di Diagnostica Generale e Benessere Animale; Istituto Zooprofilattico Sperimentale dell'Umbria e della Marche; 06126 Perugia Italy
| | - Mark E. Peterson
- Endocrinology & Nuclear Medicine; Animal Endocrine Clinic; New York NY 10025
| | | | - Cristiano Boiti
- Dipartimento di Medicina veterinaria; Università degli Studi di Perugia; 06126 Perugia Italy
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Xu A, Hu H. The gallbladder polypoid-lesions conundrum: moving forward with controversy by looking back. Expert Rev Gastroenterol Hepatol 2017; 11:1071-1080. [PMID: 28837358 DOI: 10.1080/17474124.2017.1372188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Gallbladder polypoid-lesions (GPs) are found in 5-10% of the general population. Although the majority of GPs are asymptomatic and benign in nature, some of them can develop into cancer, which carries a poor prognosis. Currently, the risk factors, natural history and classification of GPs remain unclear, differentiation of benign from malignant or premalignant GPs based on available diagnostic modalities and/or features of patients and GPs remain difficult, and there are still no evidence-based guidelines to dictate when and how GPs of varying sizes and subtypes should be managed. All of these facts have left GPs in uncertainty. Areas covered: A literature search was performed using the terms 'gallbladder polyps' AND 'polypoid lesion of gallbladder' in the PubMed database from January 2000 to September 2016. Original and review articles on almost all aspects of GPs in humans, especially diagnosis, treatment and surveillance, were reviewed and analyzed. Reference lists of reviews and original articles were also examined for relevant publications. Expert commentary: The present article summarizes almost all aspects of GPs, analyzes the controversies, and outlines our data and comments. It is the authors' purpose that this article be beneficial for scientific, accurate and appropriate management of GPs.
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Affiliation(s)
- Anan Xu
- a Gallbladder Diseases Center , East Hospital of Tongji University , Shanghai , China
| | - Hai Hu
- a Gallbladder Diseases Center , East Hospital of Tongji University , Shanghai , China
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25
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Wiles R, Thoeni RF, Barbu ST, Vashist YK, Rafaelsen SR, Dewhurst C, Arvanitakis M, Lahaye M, Soltes M, Perinel J, Roberts SA. Management and follow-up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 2017; 27:3856-3866. [PMID: 28185005 PMCID: PMC5544788 DOI: 10.1007/s00330-017-4742-y] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Objectives The management of incidentally detected gallbladder polyps on radiological examinations is contentious. The incidental radiological finding of a gallbladder polyp can therefore be problematic for the radiologist and the clinician who referred the patient for the radiological examination. To address this a joint guideline was created by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Methods A targeted literature search was performed and consensus guidelines were created using a series of Delphi questionnaires and a seven-point Likert scale. Results A total of three Delphi rounds were performed. Consensus regarding which patients should have cholecystectomy, which patients should have ultrasound follow-up and the nature and duration of that follow-up was established. The full recommendations as well as a summary algorithm are provided. Conclusions These expert consensus recommendations can be used as guidance when a gallbladder polyp is encountered in clinical practice. Key Points • Management of gallbladder polyps is contentious • Cholecystectomy is recommended for gallbladder polyps >10 mm • Management of polyps <10 mm depends on patient and polyp characteristics • Further research is required to determine optimal management of gallbladder polyps
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Affiliation(s)
- Rebecca Wiles
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L78XP, UK.
| | - Ruedi F Thoeni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical School, San Francisco, CA, USA
| | - Sorin Traian Barbu
- 4th Surgery Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Yogesh K Vashist
- Section for Visceral Surgery, Department of Surgery, Kantonsspital Aarau, Aarau, Switzerland.,Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Søren Rafael Rafaelsen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, University of Southern Denmark, Odense M, Denmark
| | - Catherine Dewhurst
- Department of Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital ULB, Brussels, Belgium
| | - Max Lahaye
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marek Soltes
- 1st Department of Surgery LF UPJS a UNLP, Kosice, Slovakia
| | - Julie Perinel
- Department of Hepatobiliary and Pancreatic Surgery, Edouard Herriot Hospital, Lyon, France
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26
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Wennmacker SZ, Lamberts MP, Drenth JPH, Gurusamy KS, van Laarhoven CJHM. Transabdominal ultrasound or endoscopic ultrasound for diagnosis of gallbladder polyps. Hippokratia 2016. [DOI: 10.1002/14651858.cd012233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Z Wennmacker
- Radboud University Medical Center Nijmegen; Department of Surgery; PO Box 9101 internal code 618 Nijmegen Netherlands 6500 HB
| | - Mark P Lamberts
- Radboud University Medical Center Nijmegen; Department of Gastroenterology and Hepatology; P.O. Box 9101, code 455 Nijmegen Netherlands
| | - Joost PH Drenth
- Radboud University Medical Center Nijmegen; Department of Gastroenterology and Hepatology; P.O. Box 9101, code 455 Nijmegen Netherlands
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical School; Department of Surgery; Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Cornelis JHM van Laarhoven
- Radboud University Medical Center Nijmegen; Department of Surgery; PO Box 9101 internal code 618 Nijmegen Netherlands 6500 HB
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Aliyazicioglu T, Carilli S, Emre A, Kaya A, Bugra D, Bilge O, Yalti T, Kabaoglu B, Alper A. Contribution of gallbladder polyp surgery to treatment. Eur Surg 2016. [DOI: 10.1007/s10353-016-0422-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mellnick VM, Menias CO, Sandrasegaran K, Hara AK, Kielar AZ, Brunt EM, Doyle MBM, Dahiya N, Elsayes KM. Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation. Radiographics 2016; 35:387-99. [PMID: 25763724 DOI: 10.1148/rg.352140095] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gallbladder polyps are seen on as many as 7% of gallbladder ultrasonographic images. The differential diagnosis for a polypoid gallbladder mass is wide and includes pseudotumors, as well as benign and malignant tumors. Tumefactive sludge may be mistaken for a gallbladder polyp. Pseudotumors include cholesterol polyps, adenomyomatosis, and inflammatory polyps, and they occur in that order of frequency. The most common benign and malignant tumors are adenomas and primary adenocarcinoma, respectively. Polyp size, shape, and other ancillary imaging findings, such as a wide base, wall thickening, and coexistent gallstones, are pertinent items to report when gallbladder polyps are discovered. These findings, as well as patient age and risk factors for gallbladder cancer, guide clinical decision making. Symptomatic polyps without other cause for symptoms, an age over 50 years, and the presence of gallstones are generally considered indications for cholecystectomy. Incidentally noted pedunculated polyps smaller than 5 mm generally do not require follow-up. Polyps that are 6-10 mm require follow-up, although neither the frequency nor the length of follow-up has been established. Polyps that are larger than 10 mm are typically excised, although lower size thresholds for cholecystectomy may be considered for patients with increased risk for gallbladder carcinoma, such as patients with primary sclerosing cholangitis.
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Affiliation(s)
- Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology (V.M.M.), Department of Pathology (E.M.B.), and Department of Surgery (M.B.M.D.),Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., A.K.H., N.D.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); Department of Radiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (A.Z.K.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Bhatt NR, Gillis A, Smoothey CO, Awan FN, Ridgway PF. Evidence based management of polyps of the gall bladder: A systematic review of the risk factors of malignancy. Surgeon 2016; 14:278-86. [PMID: 26825588 DOI: 10.1016/j.surge.2015.12.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are no evidence-based guidelines to dictate when Gallbladder Polyps (GBPs) of varying sizes should be resected. AIM To identify factors that accurately predict malignant disease in GBP; to provide an evidence-based algorithm for management. METHODS A systematic review following PRISMA guidelines was performed using terms "gallbladder polyps" AND "polypoid lesion of gallbladder", from January 1993 and September 2013. Inclusion criteria required histopathological report or follow-up of 2 years. RTI-IB tool was used for quality analysis. Correlation with GBP size and malignant potential was analysed using Euclidean distance; a logistics mixed effects model was used for assessing independent risk factors for malignancy. RESULTS Fifty-three articles were included in review. Data from 21 studies was pooled for analysis. Optimum size cut-off for resection of GBPs was 10 mm. Probability of malignancy is approximately zero at size <4.15 mm. Patient age >50 years, sessile and single polyps were independent risk factors for malignancy. For polyps sized 4 mm-10 mm, a risk assessment model was formulated. CONCLUSIONS This review and analysis has provided an evidence-based algorithm for the management of GBPs. Longitudinal studies are needed to better understand the behaviour of polyps <10 mm, that are not at a high risk of malignancy, but may change over time.
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Affiliation(s)
- Nikita R Bhatt
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Amy Gillis
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Craig O Smoothey
- School of Mechanical and Materials Engineering, University College Dublin, Ireland
| | - Faisal N Awan
- Department of Hepatobiliary Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, University of Dublin, Trinity College, at the Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
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Lu D, Radin R, Yung E, Tchelepi H. Malignant transformation of a 5-mm gallbladder polyp over 2 years: a case report and review of current literature. Ultrasound Q 2015; 31:66-8. [PMID: 25054905 DOI: 10.1097/ruq.0000000000000094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gallbladder polyps (GBPs) are incidentally seen in 4% to 7% of adults on abdominal ultrasounds. Most GBPs are benign cholesterol polyps, adenomyomatosis, or inflammatory polyps. Currently, cholecystectomy is widely accepted as appropriate care for polyps 10 mm or larger as they present a higher risk for malignancy. However, the management of small polyps smaller than 10 mm has continued to be a dilemma to clinicians and radiologists. Many authors support a nonoperative approach with imaging follow-up for polyps smaller than 10 mm, as most have been shown to be benign. However, small polyps do have the potential to be neoplastic adenomas and become malignant. In this report, we will describe a case of a tiny GBP that subsequently developed into a 20-mm carcinoma over a period of 2 years.
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Affiliation(s)
- Darren Lu
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA
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Babu BI, Dennison AR, Garcea G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbecks Arch Surg 2015; 400:455-62. [PMID: 25910600 DOI: 10.1007/s00423-015-1302-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/13/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs <1 cm. This systematic review examines current evidence on management of GBPs. METHODS MEDLINE, EMBASE and Cochrane library databases were searched from January 1991 to June 2013 using specified terms. A predefined protocol for data extraction was used to retrieve specified end points. RESULTS Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, <1 cm and <5 mm constituted 8.5, 1.2 and 0% of GBPs, respectively. Majority of patients requiring surgical intervention had laparoscopic cholecystectomy. CONCLUSIONS Presently employed policy of cholecystectomy for GBPs >1 cm is appropriate. For GBPs <1 cm, the authors propose (accepting existence of differing proposals) the following: 1. Surveillance may not be needed for GBPs <5 mm. 2. For GBPs between 5 and 10 mm, two scans at six monthly intervals is suggested and after that, tailor surveillance to age, growth and ethnicity. In the non-Asian population, if GBP remains the same size or number, discontinuation of surveillance may be considered. In the Asian population, if GBPs remain the same, yearly surveillance is continued for a suggested period of 3 years. 3. Discontinue surveillance if GBPs is/are smaller/ disappeared. Cholecystectomy is advised where size increases to >10 mm.
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Affiliation(s)
- Benoy I Babu
- Leicester HPB Unit, University Hospitals of Leicester, Gwendolen Road, LE5 4PW, Leicester, UK,
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Lim SH, Kim D, Kang JH, Song JH, Yang SY, Yim JY, Chung SJ, Kim JS, Cho SH. Hepatic fat, not visceral fat, is associated with gallbladder polyps: a study of 2643 healthy subjects. J Gastroenterol Hepatol 2015; 30:767-74. [PMID: 25376159 DOI: 10.1111/jgh.12841] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Gallbladder polyps (GBPs) appear to be strongly associated with obesity and metabolic disease. To date, the relationship between GBPs and fatty liver has not been adequately evaluated. The aim of the present study was to investigate whether GBPs are associated with fatty liver, which is an ectopic regional fat deposit, independent of visceral adipose tissue (VAT). METHODS A cross-sectional study using 2643 health checkup subjects (961 patients with GBP and 1682 age- and sex-matched healthy controls) was conducted. The subjects underwent various laboratory tests, abdominal fat computed tomography (CT), and hepatic ultrasonography. RESULTS The mean age of the subjects was 51.4 ± 8.3 years, and 74.1% were male. GBPs were significantly associated with fatty liver. Multivariate regression analysis revealed that GBPs were significantly associated with the presence of fatty liver (odds ratio [OR] 1.23, 95% confidence interval [CI]: 1.02-1.48), and adjusting for the homeostatic metabolic assessment index had little effect on this association (OR 1.23, 95% CI: 1.02-1.48). Additionally, GBPs remained significantly associated with the presence of fatty liver after adjustments for CT-measured VAT and subcutaneous adipose tissue (OR 1.24, 95% CI: 1.03-1.50). The degree of fatty liver showed an independent (OR 1.37 95% CI: 1.03-1.80) and dose-dependent relationship (moderate-severe fatty liver: OR 1.55 95% CI: 1.07-2.23, P for trend = 0.014) with large GBPs (≥ 5 mm). CONCLUSION Fatty liver, an ectopic regional fat deposit, was found to be closely associated with GBPs independent of known metabolic risk factors, insulin resistance, and CT-measured VAT, confirming a relevant clinical relationship between the two diseases.
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Affiliation(s)
- Seon Hee Lim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
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Lee YJ, Park KS, Cho KB, Kim ES, Jang BK, Chung WJ, Hwang JS. Shifting prevalence of gallbladder polyps in Korea. J Korean Med Sci 2014; 29:1247-52. [PMID: 25246743 PMCID: PMC4168178 DOI: 10.3346/jkms.2014.29.9.1247] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/28/2014] [Indexed: 12/20/2022] Open
Abstract
Only a few studies have evaluated the population-adjusted prevalence of gallbladder polyps (GBP). This study aimed to evaluate the changes in GBP prevalence and risk factors at a single health screening center in Korea from 2002 to 2012. Of 48,591 adults who underwent health screening between 2002 and 2012, 14,250 age- and gender-matched subjects were randomly selected to evaluate prevalence. Risk factors were analyzed between the GBP-positive and GBP-negative groups during 2002-2004 (Period A) and 2010-2012 (Period B). The annual prevalence of GBP over the 11-yr period was 5.4%. Annual prevalence increased from 3.8% in Period A to 7.1% in Period B. Male gender and obesity were independent risk factors for GBP in both periods. Hepatitis B virus surface antigen (HBsAg) positivity was a risk factor for GBP in Period A but not in Period B. The risk factors for GBP changed from HBsAg positivity to lipid profile abnormalities. Other variables including age, hypertension, diabetes, impaired fasting glucose, chronic hepatitis C virus infection, and liver function tests did not correlate with GBP. In conclusion, GBP prevalence is increasing and risk factors for GBP have changed in Korea. More attention should be paid to this issue in the future.
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Affiliation(s)
- Yoo Jin Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Sik Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Bum Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Eun Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Byoung Kuk Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Woo Jin Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Seok Hwang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Growth rate and malignant potential of small gallbladder polyps--systematic review of evidence. Surgeon 2014; 12:221-6. [PMID: 24502936 DOI: 10.1016/j.surge.2014.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 12/16/2022]
Abstract
THE BACKGROUND AND PURPOSE The overall aim of this systematic review was to determine whether ultrasound (US) follow up for gallbladder polyps (GBPs) measuring less than 10 mms is necessary. METHODS A search was performed in MEDLINE and EMBASE between January 1976 and January 2012 using keywords: gallbladder, polyps, neoplasm, cancer, tumour, carcinoma, malignant, adenoma. Included were studies involving adult patients, examined with transabdominal US at least twice. The outcomes of included studies were gallbladder polyp growth as demonstrated on US over time, followed where available by histological examination of cholecystectomy specimens. MAIN FINDINGS Ten studies met the inclusion criteria for the review. Altogether 1958 subjects with mean age between 41.5 and 59 years were followed up with US. The percentage of GBPs which showed growth over the follow up period ranged from 1% to 23%. 43 neoplastic polyps were found in total irrespective of size, 20 of which were malignant and at least 7 of those were >10 mms. At least 7 malignancies were present in polyps <10 mms but it was unknown if they had undergone growth on follow up. CONCLUSIONS Level II-2 and below evidence on rate of growth of small GBPs <10 mms exists in the literature. It indicates that growth does occur in a significant minority of small GBPs, but it is slow. Due to deficient reporting and small numbers of cases, the correlation between growth of GBP and development of malignancy cannot be established using currently available evidence. Malignancy can be present in polyps <10 mms although it is significantly more frequent in polyps >10 mms. Cholecystectomy for symptomatic GBPs irrespective of their size, alongside the current practice for removal of gall bladders containing asymptomatic polyps >10 mms, is proposed. No evidence based US follow up schedule can be recommended at present for asymptomatic polyps <10 mms, and in its absence an intuitive follow up with US is likely to continue.
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Augustine MM, Fong Y. Epidemiology and risk factors of biliary tract and primary liver tumors. Surg Oncol Clin N Am 2013; 23:171-88. [PMID: 24560105 DOI: 10.1016/j.soc.2013.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primary liver and biliary tract tumors encompass a range of benign and malignant neoplasms. They consist of histologically distinct types of tumors that arise from and are influenced by hepatocytes, biliary epithelial cells, and mesenchymal cells. Improvements in imaging have allowed the detection and diagnosis of these neoplasms to be refined. Investigation at the histologic, molecular, and genetic levels has allowed neoplasms to be categorized and treated. Epidemiology has improved understanding of geographic, ethnic, gender, and cultural differences that link exposures with cancer risk. This article focuses on the epidemiology of major primary adult liver and biliary tract tumors.
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Affiliation(s)
- Mathew M Augustine
- Hepatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA
| | - Yuman Fong
- Hepatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
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Lv FJ, Liu JW, Lv HQ, Zhang D, Han YH, Pang GD, Jiang YH, Lu J, Shan JH. Prevalence of and risk factors for gallbladder polyps in Han, Uygur and Kazak populations in Xinjiang. Shijie Huaren Xiaohua Zazhi 2013; 21:3647-3653. [DOI: 10.11569/wcjd.v21.i33.3647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence of and risk factors for gallbladder polyps in Uygur, Han and Kazak populations in Xinjiang Uygur Autonomous Region.
METHODS: Typical sampling followed by stratified random sampling was adopted. The unified questionnaire about risk factors for gallbladder diseases in Xinjiang was administered, and each participant was asked to finish a questionnaire about epidemiological data of gallbladder polyps and undergo abdominal ultrasonography of the liver and gallbladder. The survey data were input with Epidata3.
RESULTS: A total of 6024 residents aged > 18 years participated in the study between June 2011 and September 2011, accounting for 2.88/10000 of all residents in the Xinjiang Uygur Autonomous Region. 5454 participants completed the questionnaire. Their age ranged from 18 to 88 years, with a mean age of 45.2 ± 14.1 years. The overall prevalence of gallbladder polyps was 5.8%. The prevalence of gallbladder polyps in Han, Uygur, Kazak and other ethnic groups was 7.1%, 3.5%, 5.6% and 7.0%, respectively, which had a significant ethnic difference (χ2 = 22.385, P = 0.000). Logistic regression analysis showed that gender, body mass index, ethnicity and breakfast correlated with gallbladder polyps.
CONCLUSION: The prevalence of gallbladder polyps differed significantly between populations of Han, Uygur, Kazak and other ethnic groups. The prevalence of PLG correlates mainly with ethnicity, age, gender, body mass index and breakfast.
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Mao YS, Mai YF, Li FJ, Zhang YM, Hu KM, Hong ZL, Zhu ZW. Prevalence and risk factors of gallbladder polypoid lesions in Chinese petrochemical employees. World J Gastroenterol 2013; 19:4393-4399. [PMID: 23885152 PMCID: PMC3718909 DOI: 10.3748/wjg.v19.i27.4393] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China.
METHODS: All active and retired employees aged 20-90 years (n = 11098) of a refinery and chemical plant in eastern China were requested to participate in a health survey. The participants were subjected to interview, physical examination, laboratory assessments and ultrasonography. All the participants were invited to have a physical examination after a face-to-face interview. Fasting blood samples were obtained from the antecubital vein, and the samples were used for the analysis of biochemical values. Abdominal ultrasonography was conducted.
RESULTS: A total of 10461 (7331 men and 3130 women) current and former petrochemical employees attended for screening. The overall prevalence of post-cholecystectomy, gallstones and PLGs was 0.9%, 5.2% and 7.4%, respectively. Compared with the increased prevalence of either gallstones or post-cholecystectomy in older persons, PLGs were more common in the middle-aged, peaking in those aged 40-59 years. Excluding the patients with gallstones, gallstones mixed with PLGs, or those who had undergone cholecystectomy, in the remaining 9828 participants, the prevalence of PLGs in men (8.9%) was significantly higher than that in women (5.5%, P < 0.001). The analyzed risk factors with increased OR for the development of PLGs were male gender (OR = 1.799, P < 0.001), age ≥ 30 years (OR = 2.699, P < 0.001) and hepatitis B surface antigen (HBsAg) positivity (OR = 1.374, P = 0.006).
CONCLUSION: PLGs are not rare among Chinese petrochemical employees. Male gender, HBsAg positivity, and middle age are risk factors for developing PLGs.
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The diagnostic accuracy of transabdominal ultrasonography needs to be considered when managing gallbladder polyps. Surg Endosc 2013; 27:4021-5. [PMID: 23749271 DOI: 10.1007/s00464-013-3033-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/10/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transabdominal ultrasonography (TAUS) is the most commonly used modality to diagnose gallbladder (GB) disease. GB polyps are reported in 1-5.6 % of TAUS studies. Histopathologic studies suggest that there is a relationship between GB polyps and GB cancer. Previous literature suggests GB polyps reported on TAUS do not correlate well with histological findings. There have been recent advances in TAUS technology. We hypothesize the recent advances in TAUS technology have improved the accuracy of TAUS for diagnosing GB polyps. METHODS Radiology and pathology databases at our tertiary care center were retrospectively searched between January 1, 2000, and December 31, 2010. Ultrasound reports that suggested a GB polyp was present on TAUS were correlated to histopathology in cases where a cholecystectomy was performed. The pathology reports where a GB polyp was found were correlated with preoperative TAUS reports. RESULTS There were 102,740 TAUS reports referring to the GB, of which 6,612 (6.4 %) contained search terms suggesting a GB polyp was present. There were 13,278 cholecystectomy pathology reports, of which 159 (1.2 %) included a diagnosis of GB polyp. TAUS detected only 50 % of the polyps identified on histopathology. The sensitivity and specificity of TAUS for diagnosing GB polyps were 50.0 and 98.3 %, respectively. The positive and negative predictive values were 10.5 and 99.8 %. CONCLUSIONS Despite improvement in TAUS technology, the accuracy for GB polyps remains poor. This needs to be considered when managing patients with TAUS-detected GB polyps. We recommend that the decision to operate on TAUS-detected GB polyps be largely based on symptoms, and following GB polyps with TAUS should be discouraged.
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Jin W, Zhang C, He X, Xu Y, Wang L, Zhao Z. Differences between images of large adenoma and protruding type of gallbladder carcinoma. Oncol Lett 2013; 5:1629-1632. [PMID: 23760294 PMCID: PMC3678592 DOI: 10.3892/ol.2013.1248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/18/2013] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate the differences between images of large adenoma of the gallbladder and the protruding type carcinoma of the gallbladder. A retrospective study was performed on 130 patients who underwent cholecystectomy or biopsy for gallbladder polypoid lesions larger than 10 mm; among them, 20 patients were malignant and 110 patients were benign. Patients’ details including ultrasonography (US), computed tomography (CT) and magnetic resonance (MR) findings were analyzed. All patients whose lesions were >15 mm by US, had CT or MR scans to further determine the nature of the lesion; two patients who were suspected to have a malignant lesion due to their large tumor size were benign by histological examination. Distinct differences were found between large adenoma and protruding type of gallbladder carcinoma. There were distinct differences between adenomas and the protruding type gallbladder cancers, and there was a pathological basis for the differences. Benign tumors had a more homogeneous texture, had spaces between the tumor and the gallbladder wall and a relatively normal configuration of the gallbladder wall. Based on these findings, certain lesions could be definitively diagnosed as benign adenomas and could help in treatment strategy.
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Affiliation(s)
- Wangxun Jin
- Departments of Hepatology and Biliary Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, P.R China ; Department of Abdominal Tumor Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, P.R China
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Walas MK, Skoczylas K, Gierbliński I. Errors and mistakes in the ultrasound diagnostics of the liver, gallbladder and bile ducts. J Ultrason 2012; 12:446-62. [PMID: 26673428 PMCID: PMC4603237 DOI: 10.15557/jou.2012.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 11/26/2012] [Accepted: 12/03/2012] [Indexed: 12/12/2022] Open
Abstract
Ultrasonography is the most widespread imaging technique used in the diagnostics of the pathologies concerning the organs in the abdominal cavity. Similarly to other diagnostic tools, errors may occur in ultrasound examinations. They generally result from inappropriate techniques, which do not conform to current standards, or erroneous interpretation of obtained images. A significant portion of mistakes is caused by inappropriate quality of the apparatus, the presence of sonographic imaging artifacts, unfavorable anatomic variants or improper preparation of the patient for the examination. This article focuses on the examiner-related errors. They concern the evaluation of the liver size, echostructure and arterial and venous vascularization as well as inappropriate interpretation of the liver anatomic variants and the vascular and ductal structures localized inside of it. Furthermore, the article presents typical mistakes made during the diagnosis of the most common gallbladder and bile duct diseases. It also includes helpful data concerning differential diagnostics of the described pathologies of the liver, gallbladder and bile ducts. The article indicates the most frequent sources of mistakes as well as false negative and false positive examples which result from these errors. What is more, the norms used in the liver, gallbladder and bile duct evaluations are presented as well as some helpful guidelines referring to the exam techniques and image interpretation, which allows for reducing the error-making risk. The article has been prepared on the basis of the report published in 2005 by the Polish experts in the field of ultrasonography and extended with the latest findings obtained from the pertinent literature.
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Affiliation(s)
- Maria Krystyna Walas
- Ośrodek USG i Diagnostyki Biopsyjnej, Katedra i Klinika Chorób Metabolicznych CMUJ, Kraków, Polska
| | - Krzysztof Skoczylas
- Klinika Gastroenterologii Onkologicznej, Centrum Onkologii - Instytut im. Marii Skłodowskiej-Curie, Warszawa, Polska
| | - Ireneusz Gierbliński
- Klinika Gastroenterologii Onkologicznej, Centrum Onkologii - Instytut im. Marii Skłodowskiej-Curie, Warszawa, Polska
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Andrén-Sandberg A. Diagnosis and management of gallbladder polyps. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:203-11. [PMID: 22655278 PMCID: PMC3359430 DOI: 10.4103/1947-2714.95897] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gallbladder cancer is a rather uncommon disease, when it gives symptoms it has usually reached an incurable stage. Therefore, every attempt must be made to find the asymptomatic stages and look for premalignant gallbladder polyps. Even if gallbladder cancer is a rare disease, gallbladder polyps are common, only a few polyps develop to cancer. This makes gallbladder polyps another problem: which are the polyps that must be surgically removed, which shall be followed-up, or for how long? The author used the keyword “gallbladder polypsn” in PubMed and reviewed the scientific literatures published from January 2000 to December 2011. The present review article has summarized almost all respects of gallbladder polyp, including the risk factors, clinical diagnosis and management, and comments made from the author, in which clinical treatments are recommended. It is author's purpose that the 11-year-knowledge about gallbladder polyps summarized from all worlds’ literatures is enough to know how clinicians will handle the next patient with gallbladder polyp.
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Affiliation(s)
- Ake Andrén-Sandberg
- Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Yang HL, Kong L, Hou LL, Shen HF, Wang Y, Gu XG, Qin JM, Yin PH, Li Q. Analysis of risk factors for polypoid lesions of gallbladder among health examinees. World J Gastroenterol 2012; 18:3015-9. [PMID: 22736927 PMCID: PMC3380331 DOI: 10.3748/wjg.v18.i23.3015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/20/2012] [Accepted: 04/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence and risk factors of polypoid lesions of gallbladder (PLG) among the health examinees in the Shanghai region, China.
METHODS: A total of 11 816 subjects who underwent health examinations in our hospital between August 2010 and February 2011 were analyzed retrospectively. Among them, there were 7174 men and 4642 women. PLG was diagnosed by the real-time ultrasonography. Those with the body mass index (BMI) ≥ 28 were considered to be obese. Blood biochemical indices were detected with the fully automatic biochemical analyzer and hepatitis B surface antigen (HBsAg) was tested by the automated enzyme immunoassay. The correlations between the prevalence of PLG and age, sex, BMI, serum cholesterol (T-Cho), triglycerides (TG), blood sugar, HBsAg, high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), gallstone and fatty liver were investigated. After univariate analysis of 11 variables, stepwise logistic regression analysis was performed to explore the risk factors of PLG.
RESULTS: There was a significant difference in sex, T-Cho, HBsAg, HDL-C, LDL-C and fatty liver between the PLG-positive group and the PLG-negative group (332/163 vs 6842/4479, P = 0.003; 22/473 vs 295/11 026, P =0.013; 92/403 vs 993/10 328, P = 0.001; 47/448 vs 332/10 989, P = 0.001; 32/463 vs 381/10 940, P = 0.001; 83/412 vs 3260/8061, P = 0.001). No significant difference was found in the age, BMI, TG, blood sugar and gallstone between the two groups (47.3 ± 26 vs 45.1 ± 33, P = 0.173; 59/436 vs 1097/10 224, P = 0.102; 52/443 vs 982/10 339, P = 0.158; 17/478 vs 295/11 026, P = 0.26; 24/471 vs 395/10 926, P = 0.109). Logistic regression analysis showed that the sex, HBsAg and HDL-C were independent risk factors for the development of PLG in a descending order of HDL-C > HBsAg > sex.
CONCLUSION: In healthy people, the male gender, positive HBsAg, and low HDL-C confer higher risks of PLG development.
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Lim KS, Peters CC, Kow A, Tan CH. The varying faces of gall bladder carcinoma: pictorial essay. Acta Radiol 2012; 53:494-500. [PMID: 22547386 DOI: 10.1258/ar.2012.110684] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this review is to highlight the pertinent imaging features and potential pitfalls in the diagnosis and staging of gall bladder carcinoma. This condition is notoriously non-specific on imaging on many occasions, particularly in its early stages; gall bladder carcinoma shows numerous features that overlap with a large number of benign conditions, leading to delayed diagnosis and incurable disease. Radiologists should be familiar with its typical and atypical imaging features.
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Affiliation(s)
- Kian Soon Lim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Cynthia C Peters
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Alfred Kow
- Department of General Surgery, National University Hospital, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
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Konstantinidis IT, Bajpai S, Kambadakone AR, Tanabe KK, Berger DL, Zheng H, Sahani DV, Lauwers GY, Fernandez-del Castillo C, Warshaw AL, Ferrone CR. Gallbladder lesions identified on ultrasound. Lessons from the last 10 years. J Gastrointest Surg 2012; 16:549-53. [PMID: 22108768 DOI: 10.1007/s11605-011-1696-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/14/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Possible mass lesions identified on ultrasound (US) of the gallbladder may prompt an aggressive surgical intervention due to the possibility of a malignant neoplasm. AIM This study aims to utilize a large modern series of patients with gallbladder lesions identified on US to evaluate imaging characteristics consistent with malignancy. METHODS A retrospective review was conducted of gallbladder ultrasound reports and clinicopathologic data of patients with a mass identified on US. RESULTS Approximately 59,271 abdominal ultrasounds and 9,117 cholecystectomies were performed between February 2000 and February 2010. We identified 213 patients with a questionable gallbladder neoplasm on ultrasonography who underwent surgical exploration. Median age was 52 years (range=11-87 years) and 147 (69%) were females. Final pathology demonstrated no neoplasm in 130 patients (61%), while 32 patients (15%) had a wall adenomyoma, 36 (17%) had a polyp (five of which were malignant), 14 (7%) had an adenocarcinoma not arising from a polyp, and one patient had a cystic papillary neoplasm. The smaller the lesion, the more likely it was to be a pseudo-mass. For lesions measuring <5 mm on US, 83% had no lesion found on final pathology. Significant predictors of malignancy were age >52 years (p<0.001), presence of gallstones on US (p=0.004), size >9 mm (p<0.001), evidence of invasion at the liver interface (p<0.001), and wall thickening >5 mm (p<0.001). Shape (sessile or penduculated), echogenicity (echogenic or isoechoic), or presence of flow on Doppler were not predictors of malignancy. An US size of ≤ 9 mm had a negative predictive value of 100% for malignancy. CONCLUSIONS Despite improvements in imaging, most apparent lesions measuring <5 mm on US are not identified in the surgical specimen. US size >9 mm, age >52 years, US suggestion of invasion at the liver interface, and wall thickening >5 mm, especially in the presence of gallstones, should raise the suspicion of malignancy.
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Affiliation(s)
- Ioannis T Konstantinidis
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Overby DW, Apelgren KN, Richardson W, Fanelli R. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 2010; 24:2368-86. [PMID: 20706739 DOI: 10.1007/s00464-010-1268-7] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/27/2010] [Indexed: 12/13/2022]
Affiliation(s)
- D Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
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Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: is follow-up necessary?--Long-term clinical and US analysis of 346 patients. Radiology 2010; 258:277-82. [PMID: 20697115 DOI: 10.1148/radiol.10100273] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the natural history of gallbladder (GB) polyps incidentally detected at ultrasonography (US) and to propose management guidelines for these lesions based on polyp size. MATERIALS AND METHODS The HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. A database search for "polyp" in all US examinations of the GB between January 1, 1999, and December 31, 2001, at a single institution was performed. All subsequent US reports were reviewed to determine changes in GB polyp size. The electronic medical record was searched to obtain clinical and pathologic follow-up. RESULTS Three hundred forty-six patients (mean age, 51.6 years; range, 20-93 years) with GB polyps were included. There were 156 men (45%) and 190 women (55%). US follow-up (mean, 5.4 years; range, 2-11.5 years) was performed in 149 patients (43%). Polyp size was stable in 90 (60%) polyps, decreased in eight (5%), increased in one (1%), and resolved in 50 (34%). Forty-two patients (12%) underwent cholecystectomy, revealing 13 (31%) GBs with polypoid lesions, 24 (57%) with stones and no polyps, and five (12%) with neither a stone nor a polypoid lesion. Clinical follow-up (mean, 8 years; range, 5-10.4 years) was performed in 155 patients (45%). No patient had clinical evidence of GB-related disease. Overall, no cases of GB malignancy were identified in 346 patients. Mean polyp size was 5.0 mm (range, 1-18 mm). No neoplastic polyps were found at 1-6 mm, one neoplastic polyp was seen at 7-9 mm, and two neoplastic polyps were found at 10 mm or larger. CONCLUSION The risk of GB malignancy resulting from incidentally detected polyps is extremely low. Incidentally detected GB polyps measuring 6 mm or less may require no additional follow-up. Data are inconclusive regarding polyps 7 mm or greater, and further studies are warranted.
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Affiliation(s)
- Michael T Corwin
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, CC/W 308, Boston, MA 02215, USA.
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