Cholesterol Polyps Research Articles

Value of prediction model in distinguishing gallbladder adenoma from cholesterol polyp.

Gallbladder adenomatous polyp is a pre-cancerous neoplasm, and it is difficult to classify from cholesterol polyps before cholecystectomy. The study aimed to clarify the risk characteristics of gallbladder adenomas and establish a prediction model to differentiate gallbladder adenomas from cholesterol polyp lesions. From May 2019 to December 2021, the patients underwent cholecystectomy in the Shanghai Eastern Hepatobiliary Surgery Hospital were retrospectively reviewed. According to the permanent pathology test, the patients were divided into adenomas and cholesterol polyps groups. All the included cases received ultrasound equipment examinations before cholecystectomy and their clinical information were completely recorded. Then the patients' baseline characteristics and ultrasound imaging variables were analyzed by logistic regression. Finally, a predictive model for gallbladder adenomas will be established and assessed based on the independent risk factors. A total of 423 cases including 296 cholesterol polyps and 127 gallbladder adenomas were analyzed in detail. Multivariate logistic regression analysis revealed that solitary polyp lesion (OR=2.954, 95% CI 1.759-4.960, P<0.001), the maximal diameter of lesions (OR=1.244, 95% CI 1.169-1.324, P<0.001), and irregular shape of polyp lesions (OR=5.549, 95% CI 1.979-15.560, P=0.001) were the independent predictive factors of gallbladder adenomas. According to the results, regression equation of logit(P)=-3.828+1.083*number of gallbladder polyps lesions (GPLs)+0.218*diameter of GPLs+1.714*shape of GPLs was established. Area under the curve (AUC) was 0.828 (95% CI 0.782-0.874, P<0.001). When logit P>0.204, the sensitivity of estimating adenoma was 79.5%, the specificity of recognizing adenoma was 70.6%, and the whole correct ratio was 73.3%. While the AUC of diameter (10mm) being a predictive factor in this study was only 0.790 (95% CI 0.741-0.839, P<0.001). And the sensitivity and specificity of 10mm as the optimal diagnostic cutoff value to diagnose adenomas were 74.8% and 65.9%, respectively. The risk factors of solitary polyp lesion, larger diameter, and irregular morphology feature of polyp lesions were significantly related to gallbladder adenomas. And the predictive model established in the study can effectively identify adenomas from cholesterol polyps and help patients to select the optimal treatment protocol.

Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations.

Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.

Instrumental diagnosis of cholesterol polyps of the gallbladder

Gallbladder polyposis is a common pathology, the detection of which has increased significantly in recent years. The dominant form of this disease is cholesterol pseudopolyps, mainly found inwomen. Clinical manifestations of gallbladder cholesterol polyps are nonspecific,which presents certain difficulties in diagnosis.Ultrasonography is one of themost informative and accessible instrumental diagnostic methods.

Value of Conventional Ultrasound-based Scoring System in Distinguishing Adenomatous Polyps From Cholesterol Polyps.

Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm. We assessed the value of ultrasound scoring system based on independent predictive parameters in distinguishing adenomatous polyps from cholesterol polyps with the maximum size of 1.0 to 1.5 cm. We enrolled 163 patients with gallbladder polyps (1.0 to 1.5 cm) who underwent ultrasonography and cholecystectomy. Ultrasound image characteristics were compared between cholesterol polyps and adenomatous polyps in the training cohort from April 2018 to January 2020. An ultrasound scoring system was constructed in the training cohort, and its diagnostic performance was evaluated in the validation cohort from February 2020 to February 2021. Maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot were significantly different between cholesterol polyps and adenomatous polyps in the training cohort ( P <0.05). The independent predictive parameters for adenomatous polyps were lower height/width ratio, presence of vascularity and absence of hyperechoic spot. The total score was as follows: (height/width ratio, <0.9=4, ≥0.9=0) + (vascularity, present=3, absent=0) + (hyperechoic spot, absent=2, present=0). The sensitivity, specificity and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33%, 80.49%, and 78.57%, respectively. The ultrasound scoring system aids in distinguishing adenomatous polyps from cholesterol polyps, and effectively decreasing unnecessary cholecystectomy.

P-BN21 Diagnostic accuracy of transabdominal ultrasound for assessing gallbladder polyps

Abstract Background Gallbladder polyps are common findings on transabdominal ultrasound (TAUS) and their implications are not entirely clear. Current guidelines advise monitoring with serial TAUS and to offer laparoscopic cholecystectomy if criteria are met to minimise risk of malignant transformation. TAUS is easily accessible and useful at identifying gallbladder polyps, however, has limitations when differentiating between pseudopolyps and true gallbladder polyps with malignant potential. This study looks at a district general hospital’s outcomes for patients undergoing laparoscopic cholecystectomy for gallbladder polyps. Methods This retrospective study identified patients who had polyps identified on TAUS and subsequently undergone laparoscopic cholecystectomy from 2011 to 2021. We identified patients using hospital coding and subsequently assessed their pre-operative imaging and clinic letters to ensure gallbladder polyps were the reason for cholecystectomy. The size of polyp on TAUS was noted and pathology reports were assessed to determine if polyps had been correctly identified on TAUS and if these were true or pseudopolyps. Clinic letters were assessed to determine if patients were symptomatic pre-operatively. Results 66 patients were identified as having polyps pre-operatively. The size of polyp ranged from 2-19mm with a mean of 7.4mm. 39 (59%) patients were symptomatic pre-operatively. TAUS findings correlated with pathology findings of polyps in 45 (68%) patients. Of the 21 patients with no polyps on pathology: 11 had gallstones, 9 had chronic cholecystitis and 1 normal gallbladder. Of the polyps identified 44 were pseudopolyps and only 1 was a true adenoma – 39 cholesterol polyps, 3 inflammatory polyps and 2 adenomyomatosis. There was no evidence of dysplasia on the adenoma, it measured 5mm on TAUS and the patient was symptomatic. Conclusions This study highlights the limitations of TAUS in correctly identifying true polyps. The 41% of asymptomatic patients all had benign findings on pathology and likely had no benefit from surgery. Whilst TAUS is a useful method of identifying potential polyps these findings would suggest that other methods of identifying true polyps should be sought to minimise patients undergoing unnecessary surgery.

The Role of Ca 19-9, Ca 72-4, Cea and Cholesterol Levels in Predicting Malignancy in Gallbladder Polyps.

To determine the association of malignancy potential of gallbladder polyps with tumor markers and cholesterol levels, and at which value the presence of malignancy should be suspected. Observational study. University of Health Sciences, Adana City training and research Hospital from December 2017 to November 2020. Ninety patients diagnosed with gallbladder polyp by abdominal ultrasonography, were included in the study. Patients were divided into subgroups of true pseudopolyp, cholesterol-non-cholesterolpolyp, malignant-non-malignant polyp. The groups were compared in terms of age, gender, polyp size, number of polyps, preoperative total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), triglyceride, Ca 19-9 (carbohydrate antigen 19-9), Ca 72-4 (carbohydrate antigen 72-4), Cea (carcinoembryonic antigen) levels. In the true polyp group, polyp size, Ca 19-9, Ca 72-4 and Cea median values were significantly higher (p=0.001, p=0.029, p=0.003, and p=0.007, respectively); whereas, triglyceride levels were significantly lower compared to the pseudopolyp group (p=0.002). Polyp size was significantly lower in cholesterol polyp group compared to non-cholesterol polyp group (p= 0.032), and LDL and triglyceride medians were significantly higher (p=0.031, and p<0.001) in cholesterol group. Among the true polyps, polyp size, Ca 19-9, Ca 72-4 and Cea levels were significantly higher in adenocarcinoma group than non-malignant polyp groups (p<0.05). Cut-off values were determined as >11 mm AUC: 0.906 for size, >24.1 U/mL. AUC: 1.00 for Ca 19-9, >9.6 U/mL AUC: 1.00 for Ca 72-4, and >40 ng/mL AUC: 0.984 for CEA, respectively. Polyps larger than 11mm with high levels of CEA, Ca 72-4, Ca 19-9, evaluated together, may act as a guide for the clinician in predicting malignancy. The availability of economical and accessible parameters may allow a new algorithm to be developed in the treatment and follow-up approach of gallbladder polyps. Key Words: Gallbladder polpys, Ca 19-9 antigen, Ca 72-4 antigen, Tumor marker, Gallbladder cancer.

The clinical significance of preoperative serum fibrinogen levels and platelet counts in patients with gallbladder carcinoma

BackgroundGallbladder carcinoma (GBC) was the most common malignancy of biliary tract. Patients with malignancies frequently present with activated coagulation pathways, which might potentially related to tumor progression and prognosis. The purpose of the study was to investigate the clinical significance of preoperative serum fibrinogen levels and platelet counts in GBC patients.Methods The preoperative fasting serum fibrinogen levels and platelet counts of 58 patients with GBC were measured by AUV2700 automatic biochemical analyzer, as well as 60 patients with cholesterol polyps and 60 healthy volunteers. Kaplan–Meier survival analysis was applied to show the correction between fibrinogen levels and outcome after surgery.ResultsThe fibrinogen levels of patients with GBC were significantly higher than healthy gallbladder and cholesterol polyp of gallbladder (p < 0.001 and p < 0.001, respectively). In GBC, fibrinogen levels were associated with tumor depth (p = 0.001), lymph node metastasis (p = 0.002), distant metastasis (p < 0.001) and Tumor Node Metastasis (TNM) stage (p < 0.001). The levels in TNM stage IV disease were significantly higher than stage III or stage I + II disease (p = 0.048 and p < 0.001, respectively), and in TNM stage III disease were significantly higher than stage I + II disease (p = 0.002). Furthermore, the overall survival was better in low fibrinogen level group than in high fibrinogen level group (p < 0.001). However, thrombocytosis was not significantly associated with overall survivals (p > 0.05) in multivariate analysis.ConclusionsThe preoperative serum fibrinogen levels and platelet counts might be reliable biomarkers for the occurance of disease, tumor depth, lymph node metastasis, distant metastasis and advanced TNM stage in patients with GBC. The serum fibrinogen levels might be a prognostic factor to predict outcome for GBC patients suffering from surgery treatment. Anticoagulation therapy might be considered to control cancer progression in future studies.

The Role of Endoscopic Ultrasound in the Diagnosis of Gallbladder Lesions.

Gallbladder (GB) diseases represent various lesions including gallstones, cholesterol polyps, adenomyomatosis, and GB carcinoma. This review aims to summarize the role of endoscopic ultrasound (EUS) in the diagnosis of GB lesions. EUS provides high-resolution images that can improve the diagnosis of GB polypoid lesions, GB wall thickness, and GB carcinoma staging. Contrast-enhancing agents may be useful for the differential diagnosis of GB lesions, but the evidence of their effectiveness is still limited. Thus, further studies are required in this area to establish its usefulness. EUS combined with fine-needle aspiration has played an increasing role in providing a histological diagnosis of GB tumors in addition to GB wall thickness.

Is there a role for growth status in distinguishing gallbladder adenomas from cholesterol polyps? – A retrospective study based on 520 cholecystectomy patients

Introduction Gallbladder adenomas have cancerous potential and occur in 4–8.9% of gallbladder polyps. The growth status (size progression and growth rate during follow-up) of polyps and their effectiveness for predicting adenomas are poorly defined. Herein, we compared adenomas and cholesterol polyps based on the growth status and evaluated the reported risk factors in predicting neoplasm. Methods We enrolled 520 patients who underwent preoperative ultrasonic follow-up more than 6 months with post-cholecystectomy pathologically confirmed gallbladder polyps. The patients were classified into adenoma and cholesterol polyp groups. Growth status, clinical characteristics, laboratory data, ultrasonic findings were reviewed and compared between the groups. Results Seventy-nine adenomas and 441 cholesterol polyps were analyzed. The mean diameter of adenomas (cholesterol polyps) was 7.24 ± 4.36 mm (6.23 ± 2.88 mm) in the initial and 12.06 ± 4.61 mm (10.05 ± 2.95 mm) in the preoperative examination. The median size progression (range) of polyps in the cholesterol polyps [3 (0, 22)] mm was smaller than that in adenomas [4 (0, 21)] mm (p = .075). The mean growth rate of adenomas (1.07 ± 1.33 mm/6 months) was slightly faster than in cholesterol polyps (0.83 ± 1.04 mm/6 months) (p = .338). The indicators significantly associated with adenomas were age >49.5 years, lack of gallbladder polyps/cholelithiasis family history, polyp size >11.5 mm and solitary polyp (p = .005, p = .027, p = .001, and p = .021, respectively). Conclusion Growth status was not a valuable modality to distinguishing gallbladder adenomas from cholesterol polyps. Risk factors such as age, polyp size, and solitary polyp were effective in predicting adenomas.

Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from cholesterol polyps by a novel predictive scoring model

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.

Value of Contrast-enhanced Ultrasound in Differential Diagnosis between Cholesterol Polyp and Gallbladder Adenoma

Objective To compare the performance of contrast-enhanced ultrasound(CEUS)and ultrasound(US)in the differential diagnosis between cholesterol polyps and gallbladder adenomas. Methods A total of 136 patients with gallbladder polyp lesions(GPLs)and undergoing cholecystectomy in the First Medical Center of Chinese PLA General Hospital from January 2019 to October 2020 were retrospectively analyzed.All the patients underwent US and CEUS examinations before cholecystectomy.US and CEUS images of cholesterol polyps and gallbladder adenomas were compared for the evaluation of the performance of CEUS in the diagnosis of gallbladder adenomas. Results The 136 cases of GPLs included 95 cases of cholesterol polyps and 41 cases of gallbladder adenomas.Cholesterol polyps and gallbladder adenomas showed significant differences in the maximum size of GPLs( Z=-5.189, P<0.001), polyp blood flow signal(χ 2=33.630, P<0.001), vascular stalk width(Z=-7.366, P<0.001), polyp enhancement time(χ 2=22.487, P<0.001), enhancement intensity in arterial phase(χ 2=44.371, P<0.001), polyp vascular morphology(χ 2=53.814, P<0.001)and gallbladder wall integrity(χ 2=13.277, P=0.001).The sensitivity, specificity and accuracy of CEUS in distinguishing gallbladder adenomas from cholesterol polyps were 85.37%, 89.47% and 88.24%, respectively, and the area under the curve was 0.874. Conclusion CEUS can effectively distinguish gallbladder adenomas from cholesterol polyps and help patients with GPLs to select the appropriate treatment.

Is Contrast-Enhanced Ultrasound Superior to Computed Tomography for Differential Diagnosis of Gallbladder Polyps? A Cross-Sectional Study.

ObjectiveTo compare the clinical value of contrast-enhanced ultrasonography (CEUS) versus computed tomography (CT) for distinguishing neoplastic and non-neoplastic gallbladder polyps. Given whether laparoscopic cholecystectomy is needed, differential diagnosis of neoplastic and non-neoplastic gallbladder polyps is more important than benign and malignant polyps.MethodsA total of 89 consecutive patients with polypoid lesions of the gallbladder > 10 mm in size without local invasion or distant metastasis during primary screening were enrolled in this prospective and comparative study. All patients who met the inclusion criteria underwent CEUS and CT examinations prior to surgical resection. The enhancement patterns and microvascular imaging types were analyzed on CEUS. The maximum diameter and CT value of the lesions were also recorded and subjected to a comparative analysis. The clinical value of the two diagnostic methods is compared.ResultsOf the 89 patients, there were 58 (65.2%) cases of non-neoplastic polyps and 31 (34.8%) cases of neoplastic polyps. The average diameter of neoplastic polyps was significantly higher than that of non-neoplastic polyps (P<0.001). The detection rate using CEUS was 100%. The proportion of perceived non-neoplastic polyps in the nonenhanced and arterial phases were 48.3% and 77.6%, respectively, which were significantly lower than those of neoplastic polyps (93.5%, P<0.001 and 100.0%, P<0.001, respectively). However, in the venous and delayed phases, all cholesterol polyps and neoplastic polyps were perceived. CT showed that non-neoplastic polyps exhibited delayed enhancement. On CEUS 29.0% neoplastic polyps showed a perfusion defect, whereas 6.9% non-neoplastic polyps showed a perfusion defect (P=0.005). The microvascular architecture of the lesions on CEUS was categorized into 4 types: spotty, linear, branched, and spinous, and there were significant differences between the two groups (P<0.001). The sensitivities and specificities were 87.10% and 68.97% for CEUS and 83.87% and 77.59% for CT, respectively (P=0.406).ConclusionsCEUS and CT are useful for differential diagnosis of neoplastic and nonneoplastic polypoid lesions of the gallbladder. Diagnostic efficacy was comparable between CEUS and CT. Thus, CEUS is preferred over CT in the differential diagnosis of neoplastic and non-neoplastic gallbladder polyps due to its comparable diagnostic efficacy and lack of radiation dose.

Risk factors for cholesterol polyp formation in the gallbladder are closely related to lipid metabolism

BackgroundThe purpose of this study was to assess the risk factors for cholesterol polyp formation in the gallbladder.MethodsThis was a multicenter retrospective study based on pathology. From January 2016 to December 2019, patients who underwent cholecystectomy and non-polyp participants confirmed by continuous ultrasound follow-ups were reviewed. Patients in the cholesterol polyp group were recruited from three high-volume centers with a diagnosis of pathologically confirmed cholesterol polyps larger than 10 mm. Population characteristics and medical data were collected within 24 h of admission before surgery. The non-polyp group included participants from the hospital physical examination center database. They had at least two ultrasound examinations with an interval longer than 180 days. Data from the final follow-up of the non-polyp group were analyzed. The risk factors for cholesterol polyp formation were analyzed by comparing the two groups.ResultsA total of 4714 participants were recruited, including 376 cholesterol polyp patients and 4338 non-polyp participants. In univariate analysis, clinical risk factors for cholesterol polyps were age, male sex, higher body mass index (BMI), higher low-density lipoprotein (LDL), lower high-density lipoprotein (HDL), and higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. In multivariate logistic analysis, independent risk factors were age > 50 years (odds ratio [OR] = 3.02, 95% confidence interval [CI] 2.33–3.91, P < 0.001], LDL > 2.89 mmol/L (OR = 1.38, 95% CI 1.08–1.78, P = 0.011), lower HDL (OR = 1.78 95% CI 1.32–2.44, P < 0.001), AST > 40 IU/L (OR = 3.55, 95% CI 2.07–6.07, P < 0.001), and BMI > 25 kg/m 2 (OR = 1.32, 95% CI 1.01–1.72, P = 0.037).ConclusionsAge, LDL, HDL, AST, and BMI are strong risk factors for cholesterol polyp formation. Older overweight patients with polyps, accompanied by abnormal lipid levels, are at high risk for cholesterol polyps.

Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder.

An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs. 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs. 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs. 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.

Contrast-enhanced ultrasound to assess gallbladder polyps

PurposeTo assess the value of contrast-enhanced ultrasound (CEUS) in distinguishing adenomatous gallbladder polyps from cholesterol gallbladder polyps. MethodsA total of 164 patients with gallbladder polyps were retrospectively analyzed. All patients underwent B-mode ultrasound (US) and CEUS before cholecystectomy. Gallbladder polyps were divided into cholesterol polyp group and adenomatous polyp group according to pathology. Differences in patient's age, gender, maximum polyp size, number, presence of gallstones, vascularity and stalk width measured by US and vascular stalk width measured by CEUS were tested between the two groups. The diagnostic performance of specific US features was evaluated. The independent factors related with adenomatous polyps were analyzed by multiple logistic regression analyses. ResultsThere were 114 cholesterol polyps and 50 adenomatous polyps in 164 patients analyzed in the study. Differences in maximum size, vascularity, and stalk width of the gallbladder polyp were significant between the two groups (p < 0.05), whereas differences in patient's age, gender, number of gallbladder polyp, and presence of gallstones between the two groups were not (p > 0.05). Stalk width was wider than vascular stalk width between the two groups (p < 0.05). Vascular stalk width was also statistically different between the two groups (p < 0.05). The diagnostic performance of vascular stalk width was more significant than stalk width. Only vascular stalk width and vascularity were independent factors related with adenomatous polyps. ConclusionVascular stalk width measured by CEUS is more accurate than stalk width measured by grayscale US in distinguishing adenomatous polyps from cholesterol polyps.

Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion.

To compare the diagnostic value of high frame rate contrast-enhanced ultrasound (H-CEUS) in distinguishing gallbladder adenomas from cholesterol polyp lesions with that of CEUS. This study enrolled 94 patients with gallbladder polyp lesions (GPLs) who underwent laparoscopic cholecystectomy. CEUS and H-CEUS were performed before surgery. The perfusion features of GPLs and the final diagnosis as determined by both technologies were compared. There were differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on H-CEUS (p < 0.05), while there were no differences in vascular types between gallbladder adenomas and cholesterol polyp lesions observed on CEUS (p > 0.05). In the cholesterol polyp lesion group, there were no differences in vascular types between CEUS and H-CEUS (p > 0.05), while the vascular types were different between CEUS and H-CEUS in the gallbladder adenoma group (p < 0.05). The diagnostic value of H-CEUS in distinguishing gallbladder adenomas from cholesterol polyp lesions was better than that of CEUS. H-CEUS improved the time resolution by increasing the frame rate, which helped to accurately reflect the difference in the microcirculation of GPLs and improved the ability of a differential diagnosis between cholesterol polyp lesions and adenomas. H-CUES may provide an effective means of imaging for patients with GPLs regarding the choice of treatment options. • High frame rate CEUS improves the time resolution of CEUS by increasing the frame rate. • High frame rate CEUS is helpful to accurately evaluate the microvascular morphology of a gallbladder polyp lesion in the arterial phase. • High frame rate CEUS helps patients with gallbladder polyp lesions to choose the appropriate treatment means.

Gallbladder polyps: modern approaches to diagnostics and treatment

Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, benign tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.

Imaging based flowchart for gallbladder polyp evaluation

BackgroundPreoperative differentiation between neoplastic and nonneoplastic gallbladder polyps, and the subsequent indication for cholecystectomy remains a clinical dilemma. The current 1 cm size threshold for neoplasia is unspecific. The aim of this study was to improve diagnostic work-up for gallbladder polyps using sonographic and MRI characteristics of neoplastic and nonneoplastic polyps. MethodsA prospective, exploratory study including patients undergoing cholecystectomy for gallbladder polyp(s) was conducted. Patients underwent targeted transabdominal ultrasound (TAUS) and MRI. Outcomes were sensitivity and specificity for polyp diagnosis, and the radiological characteristics of neoplastic and nonneoplastic polyp types. Histopathology after cholecystectomy was used as reference standard. ResultsHistopathology demonstrated gallbladder polyps in 20/27 patients (74%): 14 cholesterol polyps, three adenomyomatosis, two adenomas and one gastric heterotopia. Sensitivity of polyp identification were 72% (routine TAUS) and 86% (targeted TAUS and MRI). Both adenomas were identified as neoplastic on targeted TAUS and MRI. Sonographic presentation as multiple, pedunculated polyps, either heterogeneous or with hyperechoic foci, or as single polyps containing cysts were limited to nonneoplastic polyps. On MRI hyperintense polyps on T1-weighted image were cholesterol polyps. An adenoma with high-grade dysplasia showed foci of decreased ADC values. We propose a checklist for polyp evaluation by targeted TAUS and a flowchart for radiological work-up of gallbladder polyps. ConclusionsThe presented checklist and flowchart could aid diagnostic work-up for gallbladder polyps compared to current routine ultrasound, by elimination of nonneoplastic polyps and ultimately improve treatment decision for patients with gallbladder polyps.

Gallbladder Polyp; When Surgical Treatment is Necessary?

Objective: Gallbladder polyps (GBP) are the lesions that are originated from the mucosa of the gallbladder and reach out to the lumen. The biological behaviours of GBP have still been uncertain, their follow-ups and treatments are controversial as they carry the risk of malignancy. Our aim is to present the results of patients who have been operated on with the diagnosis of GBP in this study.Methods: This retrospective study was conducted at Department of General Surgery, Giresun University. Patients who underwent surgery for GBP were included between January 2015 and December 2019. The age, gender, symptoms, ultrasonography findings (numbers polyps, types and presence of polyp and stone), surgery method (open and laparoscopic), and histopathological examination results were analysed.Results: A total of 1486 cholecystectomies, including 1388 laparoscopic cholecystectomy and 98 open cholecystectomies, were performed. One-hundred thirty-two (8.8%) of these patients were operated with the diagnosis of the GBP. One-hundred thirty of them were operated with the laparoscopic method and two of them with the open surgical method. Overall, fourty two (31.8%) of the patients were male and 90 (68.2%) were female. The average age was 48.7. One-hundred one (76.5%) patients were clinically symptomatic. Gallstones were analysed in 35 (26.5%) patients. Multipl polyps were detected in 34 (25.8%) patients. There were no polyps determined in 47 (35.6%) patients the histopathological examination. The most common polyp type was cholesterol polyps (%64.8). Cancer histopathology was not found in any patient.Conclusion: It is difficult to differentiate premalign and/or malignant lesions of the gallbladder from benign lesions. Therefore, we believe that surgical treatment is the correct approach for all GBP, which are symptomatic, accompanying stones, and that have a risk of malignancy ultrasonographically.

Cholesterolosis of the gall bladder: a surgical dilemma

Cholesterolosis of the gall bladder or cholesterol polyps of the gall bladder have always been a contentious issue with respect to the role of prophylactic surgery in view of its asymptomatic state. Symptomatic cholesterol polyps behave similar to gall stones. There is therefore a need for a surgical algorithm to manage these lesions. A case of symptomatic cholesterol polyps of the gall bladder is reported to highlight the clinical presentation, imaging modalities and management strategies. Symptomatic cholesterol polyps of the gall bladder necessitate cholecystectomy. However, surgical intervention for asymptomatic polyps is guided by their size. Increased diameter is highly suspicious of a malignant potential requiring pre-operative staging and radical surgery.