Is gall-bladder polyp equivalent to cancer? An analysis of material from 1196 cholecystectomies--a comparison of the ultrasound and histopathological results.

Abstract

Polyps of the gall-bladder has long been a serious diagnostic problem. Their detection in routine ultrasound is not yet satisfactory and often does not allow you to select the proper method of operating the gall-bladder. The aim of the study was to assess the accuracy of ultrasound diagnosis of polypoid lesions of the gall-bladder through its verification by histopathology in patients treated with cholecystectomy. In the years 2010-2013, 1196 patients underwent surgery due to diseases of the gall-bladder at the Department of General and Transplant Surgery, Medical University in Łódź. The study evaluated the sensitivity of ultrasound in detecting polyps of the gallbladder and histopathological findings of the formulations investigated. Preoperative ultrasound examination (USG) revealed a polypoid lesion in 64 patients; only in 29 of them (44.6%) this diagnosis was confirmed by histopathological examination. In the other cases, cholecystolithiasis or inflammatory lesions were found. The most common histopathological findings included cholesterol polyps, adenomatous polyps, and inflammatory polyps. Malignant lesions (gall-bladder cancer) were found in five patients preoperatively diagnosed with a polypoid lesion, i.e 7.8% of patients preoperatively diagnosed with a polyp and 0.4% of all patients who received surgical treatment. Patients qualified for surgery due to polyps diagnosed by means of ultrasound examination constitued 5.4% of all patients who underwent cholecystectomy. On histopathological examination, the presence of polyps was confirmed in 2.4% patients treated with excision of the gall-bladder. Detection of gall-bladder polyp on ultrasound examination is an indication for cholecystectomy, in particular when the polyp diameter exceeds 10 mm. In each case of a polyp, cholecystolithiasis should also be taken into account and the presence (or absence) of indications for cholecystectomy should be discussed with the patient.