Abstract
Adenomatous gallbladder polyps, premalignant lesions of the gallbladder, have fatal outcomes, whereas cholesterol polyps have benign features. Herein, we proposed a novel, predictive scoring model of adenomatous polyps to distinguish them from cholesterol polyps, by analyzing bile components and bile viscosity. Patients with gallbladder polyp pathologically confirmed after cholecystectomies were analyzed. After dividing patients into two groups (adenomatous or cholesterol polyps), the clinicopathologic profiles and bile nature, including components and viscosity were compared and a predictive scoring model for adenomatous polyps was assessed. Eleven adenomatous polyps and 96 cholesterol polyps were analyzed. The variables significantly associated with adenomatous polyps were age > 55 years (odds ratio [OR] = 23.550, p = 0.020), bile viscosity < 7.5 sec-1 (OR = 22.539, p = 0.012), and bile cholesterol < 414.5 mg/dL (OR = 10.004, p = 0.023) and the points for each variable in the predictive scoring model were allocated as 3, 3, and 2, respectively. Final scores ranged from 0 to 8 points and the best performance of model at a cutoff of ≥ 6 points had 90.9% of sensitivity and 80.2% of specificity. Bile viscosity and bile cholesterol accompanied by age were revealed as significant predictors of adenomatous polyps, distinguishing them from cholesterol polyps of gallbladder. It can be the cornerstone for creating accurate guidelines for preoperatively determining treatment strategies of gallbladder polyps.
Highlights
Adenomatous gallbladder polyps, premalignant lesions of the gallbladder, have fatal outcomes, whereas cholesterol polyps have benign features
Bile viscosity and bile cholesterol accompanied by age were revealed as significant predictors of adenomatous polyps, distinguishing them from cholesterol polyps of gallbladder
It can be the cornerstone for creating accurate guidelines for preoperatively determining treatment strategies of gallbladder polyps
Summary
Adenomatous gallbladder polyps, premalignant lesions of the gallbladder, have fatal outcomes, whereas cholesterol polyps have benign features. About 2% of the GBPs have malignant potential and are considered true polyps, most of which are adenomas. These premalignant lesions could proceed to gallbladder cancer, usually with a dismal prognosis as the stage advances. It is crucial to early and accurately distinguish between adenomas that require true surgical resection and cholesterol polyps, which account for a significant proportion of the GBPs. According to previously published guidelines from various committees [5], polypoid lesions with a size of 10 mm or more on ultrasound examination are considered to have malignant potential and cholecystectomy is recommended. The differences in these polyp traits and bile components can be helpful to distinguish premalignant lesions from benign lesions
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