Gallbladder Polyps: Correlation and Agreement Between Ultrasonographic and Histopathological Findings in a Population With High Incidence of Gallbladder Cancer

Abstract

BACKGROUND: Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions. AIMS: The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs). METHODS: Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study. RESULTS: A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74–0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56–23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78. CONCLUSIONS: There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.

Current considerations for the surgical management of gallbladder adenomas

“…Gallbladder polyps affecting 5%-10% of the adult population, consist of nonneoplastic cholesterol pseudopolyps in the vast majority of cases and they are usually discovered incidentally[ 1 ]. Adenomas or true neoplastic polyps are rare benign lesions that represent 0.5% of gallbladder neoplasms and 3%-9% of gallbladder polyps[ 2 - 5 ]. However, they can have malignant potential according to their size, which leads to gallbladder cancer with poor prognosis (a 5-year overall survival of 5%-8%)[ 6 ].…”

Acute Cholecystitis in High-Risk Patients. Surgical, Radiological, or Endoscopic Treatment? Brazilian College of Digestive Surgery Position Paper

“…Coagulopathy should be adequately corrected before the procedure 11 . Another relative contraindication for PC is gallbladder cancer due to the possibility of neoplastic dissemination 24 .…”

The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication

“…Gallbladder polyps are common benign outgrowth of the mucosal wall of the gallbladder which are often found incidentally when investigating cause of the abdominal pain 1,2 . The widespread use of abdominal ultrasound scan as part of abdominal pain diagnostic pathway has increased detection rates of gallbladder polyps 2 .…”

“…Gallbladder polyps are common benign outgrowth of the mucosal wall of the gallbladder which are often found incidentally when investigating cause of the abdominal pain 1,2 . The widespread use of abdominal ultrasound scan as part of abdominal pain diagnostic pathway has increased detection rates of gallbladder polyps 2 . While most radiologically‐detected gallbladder polyps are either inflammatory polyps or pseudo‐polyps (cholesterol polyps) which are benign and rarely exceed 1 cm in diameter, true adenomatous gallbladder polyps are rare but have malignant potential 1 .…”

“…Routine follow‐up of gallbladder polyps may encounter some issues. First, gallbladder polyps are very common while gallbladder cancer is uncommon 1–4 . Although the number needed to investigate or treat is not reported by available literature, it is evident that a large number of gallbladder polyps should be followed‐up to detect one gallbladder cancer.…”