The value of CT findings combined with inflammatory indicators for preoperative differentiation of benign and malignant gallbladder polypoid lesions

Abstract

Background The study aimed to explore the value of CT findings and inflammatory indicators in differentiating benign and malignant gallbladder polypoid lesions before surgery. Methods The study comprised a total of 113 pathologically confirmed gallbladder polypoid lesions with a maximum diameter ≥ 1 cm (68 benign and 45 malignant), all of which were enhanced CT-scanned within 1 month before surgery. The CT findings and inflammatory indicators of the patients were analyzed by univariate and multivariate logistic regression analysis to identify independent predictors of gallbladder polypoid lesions, and then a nomogram distinguishing benign and malignant gallbladder polypoid lesions was developed by combining these characteristics. The receiver operating characteristic (ROC) curve and decision curve were plotted to assess the performance of the nomogram. Results Base status of the lesion (p < 0.001), plain CT value (p < 0.001), neutrophil–lymphocyte ratio (NLR) (p = 0.041), and monocyte-lymphocyte ratio (MLR) (p = 0.022) were independent predictors of malignant polypoid lesions of the gallbladder. The nomogram model established by incorporating the above factors had good performance in differentiating and predicting benign and malignant gallbladder polypoid lesions (AUC = 0.964), with sensitivity and specificity of 82.4% and 97.8%, respectively. The DCA demonstrated the important clinical utility of our nomogram. Conclusion CT findings combined with inflammatory indicators can effectively differentiate benign and malignant gallbladder polypoid lesions before surgery, which is valuable for clinical decision-making.

Discrimination between benign and malignant gallbladder lesions on enhanced CT imaging using radiomics

“…Accurate differentiation between benign and malignant gallbladder lesions is crucial for determining appropriate patient management and improving patient outcomes (13). Herein, we developed a prediction model using radiomics analysis to differentiate between benign and malignant gallbladder lesions on enhanced CT imaging.…”

Contemporary diagnosis and management of gallbladder polyps

“…[91] The presence of gallstones, age, CEA, size and sessile polyps have been considered independent predictors of neoplastic potential in a nomogram model. [92,93] Another nomogram established by multivariate regression analysis and based on CT evaluation along with inflammation markers such as neutrophillymphocyte ratio and monocyte-lymphocyte ratio has been proposed for discrimination between benign and malignant GB polyps. [94] A survey among fellows of the Society of Radiologists in Ultrasound for the evaluation and management recommendation of GB polyps showed size (100%), wall thickening (76%) and shape (67%) as important parameters.…”

The New Perspectives Journal of Medicine

“…其他 其他与GC发展相关的危险因素包括女性 (37)(38)(39) 、烟草 (39)(40)(41) 、糖尿病 (39,42,43) 、肥胖 (37,38,44) 以及先天性胆道异常 (45) 等。特别是在绝经前女性中，肥胖对GC风险的提高尤为 显著 (44) 声(endoscopic ultrasound, EUS)、超声造影(contrastenhanced ultrasonography, CEUS)等可能有助于我们在疑 难病例中做出决策 (20) 。TAUS很擅长区分胆囊有无息肉， 而且有着经济、方便等优点，但在鉴别真性与假性GP以 及GP的良恶性方面不太准确，而且容易混淆GP与胆囊嵌 顿性结石 (9,47) 。HRUS与TAUS相比可以更好地评估胆囊 壁层，更准确地分析GP的内部回声变化 (48) 。比如肿瘤性 GP中的低回声灶，这是预测肿瘤性GP的强烈因素 (49) 。此 外，HRUS有助于区分GADM和早期胆囊壁增厚型GC，也 有助于对GC进行TNM分期中的T类(Tumor)分期 (49,50) 。 EUS的超声探头可在比TAUS更近的距离检查胆囊，具有 较高的空间分辨率，所以在GP定性诊断和肿瘤浸润深度 评估方面更详细 (51) 。CEUS在鉴别GP良恶性方面同样具有 重要价值。CEUS可实时显示病灶内的血流灌注，通过观 察病灶的增强模式、血管形态特征以及局部胆囊壁的连 续性，可对病灶性质做出判断 (52,53) 。如果CEUS发现病灶 内出现分枝状、线状血管以及胆囊壁破坏，则高度提示 恶性GP (54) 。Zhang等发现，与TAUS相比，CEUS诊断胆囊 恶性病变，敏感度(94.1% vs. 82.4%, P=0.301)和特异度 (95.5% vs. 89.8%, P=0.124)略有提高 (55) 。 5.2. 计算机成像 计算机成像(computed tomography, CT)诊断GP的 灵敏度不高，特别是对于<10mm的GP作用有限，但有 助于鉴别肿瘤性GP、恶性GP以及术前定位 (1,9,56) 。Satoh 等的研究发现，CT对GC的检出率明显高于胆固醇型GP (73% vs. 10%, P<0.01)，这与病变的脂质含量和细胞 密度有关 (57) 。而且，在CT上的可检测性是预测GC的独 立预测因子(P=0.045, OR=27.1, 95% CI: 1.07-685)。 CT仿真内镜(CT virtual endoscopy, CTVE)可以重建出 空腔器官内表面的立体图像，显示GP的立体结构。对比 增强CT(contrast-enhanced CT, CE-CT)比CT平片更有 助于鉴别GP的良恶性 (58) 。Yuan等的研究中CE-CT对于肿 瘤性GP的敏感度和特异度分别为83.87%和77.59%，整体 准确性与CEUS相当(P=0.406)；而对于恶性GP的敏感 度和特异度分别为93.15%和75.00%，同样与CEUS相当 (P=0.362) (59) 。不过此研究的局限是只纳入了>10mm的 GP。对于已出现明显胆囊壁侵犯并高度怀疑恶性的GP， CE-CT可用于判断病灶的分期和肝脏浸润深度 (60) 。此外， CT检查结果结合炎症指标在术前鉴别和预测GP的良恶性 方面具有良好的效能(AUC=0.964) (61) 。 5.3. 磁共振成像 恶性GP在磁共振成像(magnetic resonance imaging, MRI)上通常表现为早期和持续的强化影，而良性GP表 现为早期的强化影并迅速消退 (62) 。此外，在弥散加权磁 共振成像(diffusion-weighted magnetic resonance imaging, ...…”