Gallbladder polyp size and risk of neoplasia

Abstract

Introduction: Gallbladder carcinoma is the most common biliary tract carcinoma. A subset develops in polypoidal precursors that are detectable by ultrasound but are not reliably distinguishable from non-neoplastic polyps. Most guidelines recommend cholecystectomy for polyps ≥ 10mm based on a higher rate of neoplasia, however, disagreements exist with management recommendations for smaller incidentally detected polyps. We investigated gallbladder polyps examined at a single institution to determine the relationship between polyp size and a finding of neoplasia. Methods and results: 136 gallbladders (F:M = 2.3:1) with a pre-operative diagnosis and histologically confirmed polyp were identified. 59.6% of polyps were <6 mm and 80.9% <10 mm. 21 (15.4%) of all polyps were neoplastic. Twenty-one point eight percent of polyps ≥6 mm and 30.8% of polyps ≥10 mm were neoplastic. Eighty-eight point nine percent of polyps showing either high grade dysplasia or carcinoma were ≥6 mm (including all carcinomas). Conclusion: Our results are in line with previously published data and reinforce the relationship between polyp size and risk of neoplasia and, more importantly, carcinoma. All polyps ≥10 mm should be well sampled to look for advanced neoplasia.