Is cholecystectomy a reasonable treatment option for simple gallbladder polyps larger than 10 mm?

Table 1 Demographic and clinical characteristics of 836 patients n (%)

Characteristics	n = 836
Female	449 (54)
Age (yr)	47 ± 12.3
Indication for surgery1
Size ≥ 10 mm	695 (83)
Increased size2	184 (22)
Abnormal imaging3	59 (7)
Size of the polyp (mm)	11.6 ± 3.5
Number of polyps
1	460 (55.0)
2	128 (15.3)
≥ 3	248 (29.6)
BMI (kg/m2)	26.7 ± 32.1
Total cholesterol (mg/dL)	172.9 ± 33.2
Total bilirubin (mg/dL)	0.8 ± 0.6
ALT (U/L)	32.1 ± 31.3
ALP (U/L)	61.8 ± 25.9
Fasting glucose (mg/dL)	110.3 ± 30.4
CA 19-9 (U/mL)	12.4 ± 38.0
HBsAg positivity	67 (8.0)

¹Repetition was allowed;

²If the polyp size was increased during the follow-up period compared to that in the initial imaging study;

³Gallbladder wall thickness, irregular margin of the polyp, enhancing nodule. GB: Gallbladder; BMI: Body mass index; ALT: Alanine transaminase; ALP: Alkaline phosphatase; CA19-9: Carbohydrate antigen 19-9; HBsAg: Hepatitis B surface antigen.

Table 2 Predictors of gallbladder cancer (multiple logistic regression analysis)

Variables	GB cancer
	OR (95%CI)	P value
Female	0.615 (0.276-1.370)	0.234
Size	1.516 (1.356-1.694)	< 0.001
Number of polyps	0.812 (0.531-1.244)	0.339
Age	1.120 (1.078-1.164)	< 0.001
Symptoms1	5.019 (1.649-15.276)	0.005
BMI	1.004 (0.995-1.014)	0.383
Total cholesterol	0.991 (0.980-1.003)	0.139
Total bilirubin	1.534 (0.604-3.894)	0.368
ALT	1.007 (0.999-1.015)	0.079
ALP	1.001 (0.991-1.012)	0.813
Fasting glucose	1.002 (0.991-1.013)	0.771
CA19-9	1.022 (0.005-1.049)	0.116
HBsAg positivity	2.461 (0.587-10.327)	0.218

¹Right upper quadrant pain, epigastric pain, vague abdominal discomfort, dyspepsia, fatigue, body weight loss. GB: Gallbladder; BMI: Body mass index; ALT: Alanine transaminase; ALP: Alkaline phosphatase; CA19-9: Carbohydrate antigen 19-9; HBsAg: Hepatitis B surface antigen.

Table 3 Receiver operating characteristic curve summary statistics

Size, mm (patients)	Sensitivity	Specificity	Youden’s index	ppv	npv
8 (54)	1.000	0.103	1.103	0.074	1.000
9 (87)	0.982	0.144	1.126	0.076	0.991
10 (105)	0.982	0.196	1.178	0.081	0.994
11 (89)	0.982	0.446	1.428	0.113	0.997
12 (127)	0.982	0.560	1.542	0.138	0.998
13 (69)	0.911	0.718	1.629	0.188	0.991
14 (41)	0.804	0.799	1.603	0.223	0.983

Ppv: Positive predictive value; npv: Negative predictive value.

Table 4 Characteristics of patients with malignant borderline-sized gallbladder polyps

Case	Sex/age (yr)	Symptom	Underlying disease	Imaging finding	Operation	TNM stage	Prognosis
1	F/49	Dyspepsia	-	12 mm, polyp	Lap.chole	T2N0M0	63 mo, alive
2	F/52	-	Hypothyroidism	12 mm, enhancing nodule	Lap.chole	T1aN0M0	30 mo, alive
3	F/60	-	-	12 mm, enhancing nodule	Lap.chole	T1aN0M0	24 mo, alive
4	F/81	-	CHF, A fib	12 mm, enhancing sessile nodule	Lap.chole	T2N0M0	13 mo, alive

Lap.chole: Laparoscopic cholecystectomy.