Polypoid lesions of the gallbladder: diagnosis and indications for surgery

Abstract

One hundred and eighty-two patients with an ultrasonographic and/or pathological diagnosis of polypoid lesions of the gallbladder (PLG) were reviewed to determine the reliability of ultrasonography in the diagnosis of PLG and the indications for operation in this disease. Of the 182 patients operated on, PLG were demonstrated by the gross appearance of the resected gallbladder in 172. Histologically benign lesions were present in 159 gallbladders and malignant lesions in 13. Cholesterol polyps accounted for most benign PLG. The sensitivity of ultrasonography in detecting PLG was 90.1 per cent, significantly higher than that of oral cholecystography, computed tomography or endoscopic retrograde cholangiopancreatography (P less than 0.01). The specificity of ultrasonography in the diagnosis of PLG was 93.9 per cent. Therefore, ultrasonography is a highly sensitive method for investigating PLG, and the preoperative diagnosis of PLG in this unit has now become entirely dependent on this technique. The size and number of PLG, the presence of gallstones and the patient's age all correlate with the nature of PLG, and these features are helpful in differentiating malignant from benign lesions before operation. Surgical treatment is indicated when PLG exceed 1.0 cm in diameter, when PLG are single in number, when PLG are associated with gallstones, when patients with PLG are over the age of 50 years, or when clinical symptoms of PLG are apparent.

Management Strategies for Gallbladder Polyps: Is It Possible to Predict Malignant Gallbladder Polyps?

“…Several studies have sought to identify the risk factors of malignant GB polyps (Table 5). [11][12][13][17][18][19][20][21] In addition, we analyzed the pathologic characteristics of cholecystectomy cases to determine whether there is any possibility of premalignant lesions of the malignant GB polyps (Fig. 2).…”

Is it necessary to perform prophylactic cholecystectomy for all symptomatic gallbladder polyps diagnosed with ultrasound?

“…As a result of wide use of routine abdominal US, the frequency of detecting the elevated lesions of the gallbladder called PLGs has increased such as 4.0-5.6% in healthy subjects (2,4,7,13). Adenomas and carcinoma in situ are classified as neoplastic polyps and the rest are non-neoplastic, according to current accepted classification (3).…”

“…Our study also reveals the inaccuracy of gallbladder US for the diagnosis of PLGs, thus the correct diagnosis by US confirmed with the pathology was 45.12%. Even recent advances in the diagnostic imaging modalities rapidly develops, it is still difficult to differentiate tumorous polyps from non-tumorous ones before surgery, thus there is no general agreement about the indications for cholecystectomy (3,7,13). Although the incidence of the carcinoma is low in PLGs, being afraid of developing cancerous changes of gallbladder polyps, surgery is preferred by also many patients and surgeons.…”

“…The prevalence of PLGs in healthy people according to US findings is reported as 4.0-5.6%. On the other hand the frequency in cholecystectomy specimens is between 2.6% and 12.1% (4)(5)(6)(7)(8)(9)(10). In 1970 a simplified classification of benign tumors and pseudotumors were offered that allows separation of neoplastic conditions from non-neoplastic ones on the basis ofMobile, dependent echogenic foci within the gallbladder lumen with posterior acoustic shadowing in the ultrasonographic examination was accepted as criteria for the diagnosis of gallstones.…”

Our surgical experience in gall bladder polyps

“…Poliplerin görülme sıklığı, farklı serilerde farklılıklar göstermekle birlikte, %0.5-11 olarak saptamaktadır (2,3). Hastalık kırklı yaşlarda ve kadınlarda daha sık görülür (4).…”