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Ibrahim MA, El Kouzi Z, Hachicho F, Kobeissi L, Ahmad JH, Sharara AI. Real-World Management and Economic Burden of Gallbladder Polyps. J Clin Gastroenterol 2025:00004836-990000000-00449. [PMID: 40372986 DOI: 10.1097/mcg.0000000000002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Accepted: 04/14/2025] [Indexed: 05/17/2025]
Abstract
BACKGROUND Gallbladder polyps (GBP) are found incidentally on imaging in ∼5% of the general population. Most are asymptomatic and only a very small percentage are malignant. This study examines real-world clinical practice management of GBP and adherence to the updated joint European guidelines. METHODS Patients with GBP between January 2019 and October 2022 were included. Clinical, radiologic, and surgical data were collected retrospectively. RESULTS One hundred thirty-eight patients were included (mean age 47.0±14.1; female 46.4%). The average follow-up period was 30.6±40.8 months. During the study period, only 26.0% of patients had an increase in GBP size. There were no predictors for GBP growth. Cholecystectomy was performed in 30 patients: 19 (63.3%) had GBP as the indication, and in those, only 9/19 (47.4%) had proper indications according to guidelines. No malignant polyps were found, and no GBP-related deaths were reported. Increased polyp size (P<0.0001) and number (P=0.014) during follow-up were significantly associated with cholecystectomy. Of the 104 patients who did not have surgery, 70 (67.3%) had no indication for follow-up imaging, but 42 (60%) were advised to continue follow-up. The average increased cost of guideline-inconsistent follow-up imaging was >$51,000 and >$67,000 for unindicated cholecystectomies, bringing total waste expenditures to >$118,000. CONCLUSION The natural history of GBP does not justify close or prolonged follow-up, especially in young individuals without risk factors. Poor adherence to guidelines by radiologists, gastroenterologists, surgeons, and other health care providers should be addressed, offering a real opportunity for medical education and significant health care savings.
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Affiliation(s)
- Mohamad Ali Ibrahim
- Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
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Tokumitsu Y, Kawaoka T, Matsukuma S, Harada E, Suenaga S, Tanabe M, Takahashi H, Shindo Y, Matsui H, Nakajima M, Ioka T, Takami T, Ito K, Tanaka H, Hamano K, Nagano H. A prospective observational study of laparoscopic approaches for suspected gallbladder cancer in Yamaguchi (YPB-002 LAGBY). Updates Surg 2025; 77:435-445. [PMID: 39992576 DOI: 10.1007/s13304-025-02119-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 01/26/2025] [Indexed: 02/26/2025]
Abstract
We have previously reported laparoscopic total biopsy methods for suspected gallbladder cancer (GBC). The present prospective observational study evaluated the safety and feasibility of a novel two-stage algorithm using laparoscopic total biopsy methods. The two-stage algorithm was applied for 40 patients with suspected GBC between July 2018 and September 2022. Laparoscopic whole-layer cholecystectomy (LWLC) was performed for early-stage or suspected malignant lesions without liver invasion and laparoscopic gallbladder bed resection (LGBR) was performed for lesions with an unclear border between the gallbladder and liver. The appropriate strategy could be selected postoperatively depending on the final pathological diagnosis according to examination of permanent sections of gallbladder. If preoperative imaging reveals enlarged lymph nodes (LNs) with possible metastases, LN sampling with intraoperative pathological diagnosis is performed prior to gallbladder removal to determine whether to introduce neoadjuvant chemotherapy. As the first diagnostic procedure, we performed LWLC in 30 cases, LGBR in 8 cases, and LN sampling alone in 2 cases. Median operation time was 165 min and median blood loss was 5.5 ml. No bile leakage caused by intraoperative perforation of the gallbladder was observed. Histologically, GBC was diagnosed in 16 cases (pTis, n = 2; pT1a, n = 2; pT1b, n = 2; pT2, n = 6; pT3, n = 4). Seven of the 10 pT2/3 cases underwent additional open lymphadenectomy. The two-stage algorithm using laparoscopic total biopsy methods for suspected GBC appears to represent a safe, feasible procedure that could play an important role in the optimal treatment strategy.
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Affiliation(s)
- Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Toru Kawaoka
- Department of Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, Japan
| | - Satoshi Matsukuma
- Department of Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, Japan
| | - Eijiro Harada
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Shigeyuki Suenaga
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroto Matsui
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Masao Nakajima
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Tatsuya Ioka
- Oncology Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Taro Takami
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
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Tazeoglu D, Esmer AC. Differentiation of "Polyp" and "Pseudo Polyp" in Gallbladder Polyps, Single-center Experience. Surg Laparosc Endosc Percutan Tech 2025:00129689-990000000-00312. [PMID: 40091787 DOI: 10.1097/sle.0000000000001363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 02/18/2025] [Indexed: 03/19/2025]
Abstract
OBJECTIVE The prevalence of gallbladder polyps is 0.3% to 9.5%. Gallbladder polyps are divided into polyps and pseudo polyps. We aim to determine the rate of polyps after histopathologic examination in patients who were operated on for gallbladder polyps and to choose the factors affecting the diagnosis of polyps. PATIENTS AND METHODS Patients who underwent cholecystectomy between January 2012 and January 2022 were analyzed retrospectively. Demographic data of the patients, anthropometric measurements, preoperative radiologic imaging methods, characteristics (size and number of polyps), and histopathologic results of the gallbladder after cholecystectomy were recorded. After histopathologic examination, the patients were grouped as gallbladder polyp and pseudo polyp and compared. RESULT A total of 162 (4.7%) patients were included in the study. 109 (67.3%) of the patients were in the polyp group, and 53 (32.7%) were in the pseudo polyp group. Polyp size and number were larger in the polyp group than in the pseudo polyp group and were odd in number (P = 0.03, P < 0.001). The radiologic polyp size cut-off value to identify the polyp was >8 mm (sensitivity: 84.2%, specificity: 66.0%). CONCLUSION Gallbladder polyps are a common pathology. The distinction between true and pseudo polyp is critical. Therefore, it is essential to distinguish between polyps and pseudo polyps for cholecystectomy.
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Affiliation(s)
- Deniz Tazeoglu
- Department of Surgical Oncology Osmaniye State Hospital, Republic of Turkey Ministry of Health Surgical Oncology, Osmaniye
| | - Ahmet Cem Esmer
- Department of Surgical Oncology, Antalya City Hospital, Antalya, Turkey
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Shao H, Zeng D, Zhu Y, Liu L, Zhao S, Zou H. Development and validation of a preoperative nomogram for predicting gallbladder adenoma. Surg Endosc 2025; 39:1749-1760. [PMID: 39808305 DOI: 10.1007/s00464-024-11480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 12/08/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Gallbladder cholesterol polyp (GCP) and gallbladder adenoma (GA) are easily confused in clinical diagnosis. This study aims to establish a nomogram prediction model for preoperative prediction of the risk of GA patients. STUDY DESIGN We retrospectively collected clinical data of GCP or GA patients who underwent laparoscopic cholecystectomy (LC) between January 2020 and April 2023. We compared and analyzed the differences between the GCP group and the GA group. The data were divided into a training set and a validation set in a 7:3 ratio. Independent risk factors were determined using LASSO and Logistic regression analysis, and a nomogram model was established. The model was comprehensively validated and evaluated using the area under the ROC curve (AUC), Hosmer-Lemeshow test and clinical decision curve analysis (DCA). RESULTS This study ultimately included 497 patients. The independent predictors of the nomogram model include blood type (O-type blood, OR 2.00, 95% CI 1.02-3.94; P = 0.046), number of lesions (solitary, OR 2.11; 95% CI 1.08-4.12; P = 0.033), sessile polyp (OR 2.04; 95% CI 1.06-3.92; P = 0.033), age (OR 1.10; 95% CI 1.07-1.20; P < 0.001), diameter (OR 1.30; 95% CI 1.17-1.45; P < 0.001). For the training and validation set, the area under the ROC curve (AUC) was 0.843 and 0.837, respectively, and the P-value for the Hosmer-Lemeshow test was 0.056 and 0.300, respectively. In addition, the calibration curve and DCA curve indicate that the model has accurate predictive ability and reliable clinical practicality. CONCLUSIONS The blood type, number of lesions, sessile polyp, age and diameter are significant risk factors for GA. This nomogram model can use simple and readily available clinical data to predict the risk of having GA and can assist in guiding surgical decisions.
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Affiliation(s)
- Hanrui Shao
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650106, Yunnan, People's Republic of China
| | - Di Zeng
- Department of Pathology, Baoji Central Hospital, 8 Jiangtan Road, Weibin District, Baoji, 721008, Shaanxi, People's Republic of China
| | - Ya Zhu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650106, Yunnan, People's Republic of China
| | - Lixin Liu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650106, Yunnan, People's Republic of China
| | - Songling Zhao
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650106, Yunnan, People's Republic of China
| | - Hao Zou
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650106, Yunnan, People's Republic of China.
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Chang W, Lee S, Kim YY, Park JY, Jeon SK, Lee JE, Yoo J, Han S, Park SH, Kim JH, Park HJ, Yoon JH. Interpretation, Reporting, Imaging-Based Workups, and Surveillance of Incidentally Detected Gallbladder Polyps and Gallbladder Wall Thickening: 2025 Recommendations From the Korean Society of Abdominal Radiology. Korean J Radiol 2025; 26:102-134. [PMID: 39898393 PMCID: PMC11794292 DOI: 10.3348/kjr.2024.0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/29/2024] [Accepted: 11/01/2024] [Indexed: 02/04/2025] Open
Abstract
Incidentally detected gallbladder polyps (GBPs) and gallbladder wall thickening (GBWT) are frequently encountered in clinical practice. However, characterizing GBPs and GBWT in asymptomatic patients can be challenging and may result in overtreatment, including unnecessary follow-ups or surgeries. The Korean Society of Abdominal Radiology (KSAR) Clinical Practice Guideline Committee has developed expert recommendations that focus on standardized imaging interpretation and follow-up strategies for both GBPs and GBWT, with support from the Korean Society of Radiology and KSAR. These guidelines, which address 24 key questions, aim to standardize the approach for the interpretation of imaging findings, reporting, imaging-based workups, and surveillance of incidentally detected GBPs and GBWT. This recommendation promotes evidence-based practice, facilitates communication between radiologists and referring physicians, and reduces unnecessary interventions.
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Affiliation(s)
- Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Eun Lee
- Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seungchul Han
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
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Jo IH, Paik CN, Ahn HG, You DD, Han JH, Kim HA. Predicting Neoplastic Gallbladder Polyps: The Role of Current Surgical Indications and Preoperative Images. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2025; 85:52-63. [PMID: 39849812 DOI: 10.4166/kjg.2024.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 11/22/2024] [Accepted: 11/29/2024] [Indexed: 01/25/2025]
Abstract
Background/Aims Cholecystectomy for gallbladder (GB) polyps is performed primarily based on preoperative images. This study examined the accuracy of surgical indications commonly used in clinical practice for detecting neoplastic polyps and investigated further clues for predicting neoplastic polyps. Methods This retrospective study included 385 patients who underwent a cholecystectomy for GB polyps. The predictive performances of seven surgical indications were compared by fitting the receiver operating characteristic curves. Logistic regression analysis was used to identify the candidate variables associated with predicting neoplastic polyps. Results Neoplastic polyps were identified in 18.9% (n=62) of the 385 patients assessed. The neoplastic group contained more females than males, larger polyps, more frequent solitary lesions, and lower platelet counts than the non-neoplastic group. Current surgical indications revealed an unsatisfactory prediction for neoplastic polyps. The optimal cutoff polyp size for neoplastic polyps by ultrasound (US) was larger than by computed tomography (CT) (12 mm vs. 10 mm). The proportion of pathologic neoplastic polyps was higher when both US and CT images were used than that predicted using a single test. Logistic regression analysis revealed larger polyps, increasing age, female sex, and lower platelet count to be associated with neoplastic polyps. Conclusions The current indications for cholecystectomy in GB polyps have a low predictive value for neoplastic lesions that can lead to overtreatment. Combining the polyp size from US and CT images may reduce unnecessary surgery. In addition, knowledge of the patient's age, sex, and platelet count could help make more selective surgical decisions for neoplastic polyps.
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Affiliation(s)
- Ik Hyun Jo
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Geun Ahn
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Do You
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyun Han
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun A Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Yuan K, Zhang X, Yang Q, Deng X, Deng Z, Liao X, Si W. Risk prediction and analysis of gallbladder polyps with deep neural network. Comput Assist Surg (Abingdon) 2024; 29:2331774. [PMID: 38520294 DOI: 10.1080/24699322.2024.2331774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
The aim of this study is to analyze the risk factors associated with the development of adenomatous and malignant polyps in the gallbladder. Adenomatous polyps of the gallbladder are considered precancerous and have a high likelihood of progressing into malignancy. Preoperatively, distinguishing between benign gallbladder polyps, adenomatous polyps, and malignant polyps is challenging. Therefore, the objective is to develop a neural network model that utilizes these risk factors to accurately predict the nature of polyps. This predictive model can be employed to differentiate the nature of polyps before surgery, enhancing diagnostic accuracy. A retrospective study was done on patients who had cholecystectomy surgeries at the Department of Hepatobiliary Surgery of the Second People's Hospital of Shenzhen between January 2017 and December 2022. The patients' clinical characteristics, lab results, and ultrasonographic indices were examined. Using risk variables for the growth of adenomatous and malignant polyps in the gallbladder, a neural network model for predicting the kind of polyps will be created. A normalized confusion matrix, PR, and ROC curve were used to evaluate the performance of the model. In this comprehensive study, we meticulously analyzed a total of 287 cases of benign gallbladder polyps, 15 cases of adenomatous polyps, and 27 cases of malignant polyps. The data analysis revealed several significant findings. Specifically, hepatitis B core antibody (95% CI -0.237 to 0.061, p < 0.001), number of polyps (95% CI -0.214 to -0.052, p = 0.001), polyp size (95% CI 0.038 to 0.051, p < 0.001), wall thickness (95% CI 0.042 to 0.081, p < 0.001), and gallbladder size (95% CI 0.185 to 0.367, p < 0.001) emerged as independent predictors for gallbladder adenomatous polyps and malignant polyps. Based on these significant findings, we developed a predictive classification model for gallbladder polyps, represented as follows, Predictive classification model for GBPs = -0.149 * core antibody - 0.033 * number of polyps + 0.045 * polyp size + 0.061 * wall thickness + 0.276 * gallbladder size - 4.313. To assess the predictive efficiency of the model, we employed precision-recall (PR) and receiver operating characteristic (ROC) curves. The area under the curve (AUC) for the prediction model was 0.945 and 0.930, respectively, indicating excellent predictive capability. We determined that a polyp size of 10 mm served as the optimal cutoff value for diagnosing gallbladder adenoma, with a sensitivity of 81.5% and specificity of 60.0%. For the diagnosis of gallbladder cancer, the sensitivity and specificity were 81.5% and 92.5%, respectively. These findings highlight the potential of our predictive model and provide valuable insights into accurate diagnosis and risk assessment for gallbladder polyps. We identified several risk factors associated with the development of adenomatous and malignant polyps in the gallbladder, including hepatitis B core antibodies, polyp number, polyp size, wall thickness, and gallbladder size. To address the need for accurate prediction, we introduced a novel neural network learning algorithm. This algorithm utilizes the aforementioned risk factors to predict the nature of gallbladder polyps. By accurately identifying the nature of these polyps, our model can assist patients in making informed decisions regarding their treatment and management strategies. This innovative approach aims to improve patient outcomes and enhance the overall effectiveness of care.
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Affiliation(s)
- Kerong Yuan
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, P.R. China
| | - Xiaofeng Zhang
- School of Mechanical Engineering, Nantong University, Nantong, P.R. China
| | - Qian Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P.R. China
| | - Xuesong Deng
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, P.R. China
| | - Zhe Deng
- Department of Emergency Medicine, the First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, P.R. China
| | - Xiangyun Liao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P.R. China
| | - Weixin Si
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, P.R. China
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Cho IR, Lee SH, Choi JH, Chun JW, Lee MW, Lee MH, Kim J, Lee TS, Paik WH, Ryu JK, Kim YT. Diagnostic performance of EUS-guided elastography for differential diagnosis of gallbladder polyp. Gastrointest Endosc 2024; 100:449-456.e1. [PMID: 38431102 DOI: 10.1016/j.gie.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND AIMS It is difficult to differentiate between neoplastic and non-neoplastic gallbladder (GB) polyps before surgery. EUS-guided elastography (EUS-EG) is a noninvasive complementary diagnostic method. The utility of EUS-EG in the differential diagnosis of GB polyps has not been investigated. We investigated the diagnostic performance of EUS-EG for the differential diagnosis of GB polyps. METHODS Patients with GB polyps were prospectively enrolled from June 2020 until November 2022. EUS-EG and semiquantitative evaluation of the strain ratio (SR) were performed for differential diagnosis of GB polyps. Fifty-three eligible patients were divided into 2 groups based on the final diagnosis after surgery. Patient demographics, EUS characteristics, and SR values were compared. A receiver-operating characteristic curve analysis was performed to determine the optimal cutoff SR value that discriminates between neoplastic and non-neoplastic GB polyps. RESULTS The median SR value for neoplastic polyps (32.93 [interquartile range {IQR}, 22.37-69.02]) was significantly higher than for non-neoplastic polyps (5.40 [IQR, 2.36-14.44], P < .001). Significant differences were found in SR values between non-neoplastic, benign neoplastic (23.38 [IQR, 13.62-39.04]), and malignant polyps (49.25 [IQR, 27.90-82.00]). The optimal cutoff SR value to differentiate between neoplastic and non-neoplastic polyps was 18.4. In multivariable logistic regression, SR value >18.4 (odds ratio, 33.604; 95% confidence interval, 2.588-436.292) was an independent predictor of neoplastic polyps. CONCLUSIONS EUS-EG and SR values can be used as a supplementary method for evaluating GB polyps. (Clinical trial registration number: NCT04416763.).
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Affiliation(s)
- In Rae Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Won Chun
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Min Woo Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myeong Hwan Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junyeol Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Seung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Knight J, Kamaya A, Fetzer D, Dahiya N, Gabriel H, Rodgers SK, Tublin M, Walsh A, Bingham D, Middleton W, Fung C. Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines. Abdom Radiol (NY) 2024; 49:3158-3165. [PMID: 38411693 DOI: 10.1007/s00261-024-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14 mm 'extremely low risk' or '7-14 mm' low risk polyps that decrease in size by ≥ 4 mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.
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Affiliation(s)
- Jessica Knight
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - David Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Scottsdale, Phoenix, AZ, 85259, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Andrew Walsh
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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10
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Wang K, Xu Q, Xia L, Sun J, Shen K, Liu H, Xu L, Li R. Gallbladder polypoid lesions: Current practices and future prospects. Chin Med J (Engl) 2024; 137:1674-1683. [PMID: 38420780 PMCID: PMC11268823 DOI: 10.1097/cm9.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 03/02/2024] Open
Abstract
ABSTRACT Gallbladder polypoid lesions (GPLs) refer to any elevated lesion of the mucosal surface of the gallbladder wall, and the prevalence is estimated to be between 0.9% and 12.1%. GPLs include benign polyps and malignant polyps. Benign polyps are further classified as non-neoplastic polyps and neoplastic polyps. Cholesterol polyps are the most common benign polyps and adenocarcinoma is the main type of malignant polyp. Hepatitis B virus infection, liver function abnormalities, dyslipidemia, and obesity are the main risk factors for GPLs. Studies of biological mechanisms have focused on malignant gallbladder polyps, the development of which is regulated by hormone levels in vivo , gut microbiota, inflammation, oxidative stress, Salmonella typhimurium , and related molecules. Diagnostic modalities include chemical examination and imaging examination, with imaging examination currently being the mainstay. Treatment of patients with GPLs is based on the presence or absence of symptoms, age, size of the polyps, tendency of the polyp to increase, and risk factors for symptomatic malignancy to determine whether surgery should be performed.
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Affiliation(s)
- Kun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Qingpeng Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Lu Xia
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Jianing Sun
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Kanger Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Haoran Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Linning Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
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Karahan F, Atay A, Ekinci N, Dilek ON. A case of gallbladder hemangioma detected in a patient with jaundice and suspected Klatskin tumor: case report and review of the literature. EGYPTIAN LIVER JOURNAL 2024; 14:48. [DOI: 10.1186/s43066-024-00356-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 06/13/2024] [Indexed: 02/21/2025] Open
Abstract
Abstract
Background and objective
The diagnosis and treatment of benign tumors of the gallbladder and bile ducts are difficult due to their anatomical relationships with neighboring vital organs. Hemangiomas are non-epithelial benign tumors of the gallbladder. The gallbladder is an extremely rare localization for cavernous hemangiomas. To date, 7 cases of cavernous gallbladder hemangioma have been reported in the literature. Although it is seen very rarely, the main problem is that it mimics malignant lesions. Pre-operative diagnosis of gallbladder hemangiomas is difficult. Ultrasound (US), computed tomography (CT) magnetic resonance imaging(MRI), endoscopic ultrasound (EUS), and angiography are helpful in differential diagnosis.
Here, we aimed to present our case, which is the first case of cavernous gallbladder hemangioma and obstructive jaundice in the literature.
Case presentation
A 49-year-old female patient was admitted with the complaint of pain in the right upper quadrant of her abdomen. Bilirubin levels were high due to obstructive jaundice. Abdominal CT and MRI showed an appearance in favor of hemangioma in the gallbladder. There was an increase in bile duct wall thickness on MRCP, and it was evaluated as suspicious for malignant neoplasia. The patient was operated on, and extrahepatic bile duct resection + Roux-en-Y hepaticojejunostomy procedure was performed. As a result of histopathology, hemangioma was detected in the gallbladder. There was no malignancy in the bile ducts.
Conclusion
It should be kept in mind that the mass detected in the gallbladder in a patient with jaundice who is suspected of having a bile duct tumor may also be a hemangioma.
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12
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Xiao M, Zhou Y, Wang Z, Dai W, Wang D, Wan Z, Chen Z, Li Q, Zheng S. The dysregulation of biliary tract microflora is closely related to primary choledocholithiasis: a multicenter study. Sci Rep 2024; 14:9004. [PMID: 38637624 PMCID: PMC11026428 DOI: 10.1038/s41598-024-59737-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
Bile microecology changes play an important role in the occurrence and development of choledocholithiasis. At present, there is no clear report on the difference of bile microecology between asymptomatic patients with gallbladder polyps and choledocholithiasis. This study compared bile microecology between gallbladder polyp patients and patients with choledocholithiasis to identify risk factors for primary choledocholithiasis. This study was conducted in 3 hospitals in different regions of China. Bile samples from 26 patients with gallbladder polyps and 31 patients with choledocholithiasis were collected by laparoscopic cholecystectomy and endoscopic retrograde choledocholithiasis cholangiography (ERCP), respectively. The collected samples were used for 16S ribosomal RNA sequencing and liquid chromatography mass spectrometry analysis. The α-diversity of bile microecological colonies was similar between gallbladder polyp and choledocholithiasis, but the β-diversity was different. Firmicutes, Proteobacteri, Bacteroidota and Actinobacteriota are the most common phyla in the gallbladder polyp group and choledocholithiasis group. However, compared with the gallbladder polyp patients, the abundance of Actinobacteriota has significantly lower in the choledocholithiasis group. At the genera level, the abundance of a variety of bacteria varies between the two groups, and Enterococcus was significantly elevated in choledocholithiasis group. In addition, bile biofilm formation-Pseudomonas aeruginosa was more metabolically active in the choledocholithiasis group, which was closely related to stone formation. The analysis of metabolites showed that a variety of metabolites decreased in the choledocholithiasis group, and the concentration of beta-muricholic acid decreased most significantly. For the first time, our study compared the bile of gallbladder polyp patients with patients with choledocholithiasis, and suggested that the change in the abundance of Actinobacteriota and Enterococcus were closely related to choledocholithiasis. The role of Pseudomonas aeruginosa biofilm in the formation of choledocholithiasis was discovered for the first time, and some prevention schemes for choledocholithiasis were discussed, which has important biological and medical significance.
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Affiliation(s)
- Min Xiao
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China
- Department of Surgery, Shulan (Quzhou) Hospital, Quzhou, Zhejiang, China
| | - Yankun Zhou
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China
| | - Zhengfei Wang
- Department of Surgery, Quzhou People's Hospital, Quzhou, Zhejiang, China
| | - Wenchao Dai
- Department of Surgery, Shulan (Quzhou) Hospital, Quzhou, Zhejiang, China
| | - Di Wang
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong, China
| | - Zhenmiao Wan
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong, China
| | - Zhitao Chen
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong, China
| | - Qiyong Li
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China.
- Jinan Microecological Biomedicine Shandong Laboratory, Jinan, Shandong, China.
| | - ShuSen Zheng
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- Department of Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, China.
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Alaswad M, Otry AA, Alhosainy Z, Elkordy F, Sabbah BN, Arabi TZ, Abdulkader H, Ghanayem OF, Azzam AZ, Amin T. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and intraoperative radiation therapy in the management of gallbladder cancer: a case report. Front Oncol 2024; 14:1361017. [PMID: 38634052 PMCID: PMC11021777 DOI: 10.3389/fonc.2024.1361017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Gallbladder cancer (GBC) is a rare and highly aggressive malignancy, often characterized by nonspecific clinical presentations and late diagnosis, which contribute to its poor prognosis. It is commonly detected at advanced stages, leading to low survival rates. Surgical resection is the primary treatment, with the extent of surgery depending on the T stage of the cancer. In advanced cases, surgery is only considered if it can potentially be curative. Despite various treatment approaches for advanced GBC, survival outcomes remain poor. In our case series, we introduce a novel treatment approach combining cytoreductive surgery, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Remarkably, we observed a 100% one-year survival rate, with one patient achieving eight years of disease-free survival without recurrence or metastasis. This aggressive treatment strategy did not lead to increased morbidity or mortality, suggesting its safety and feasibility. However, larger-scale studies are required to draw definitive conclusions.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ziad Alhosainy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fadwa Elkordy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | | - Ayman Zaki Azzam
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek Amin
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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14
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Sun Y, Gong J, Li Z, Han L, Sun D. Gallbladder cancer: surgical treatment, immunotherapy, and targeted therapy. Postgrad Med 2024; 136:278-291. [PMID: 38635593 DOI: 10.1080/00325481.2024.2345585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
Gallbladder cancer is a common type of biliary tract tumor. Optimal management for early stage cases typically involves radical excision as the primary treatment modality. Various surgical techniques, including laparoscopic, robotic, and navigational surgery, have demonstrated favorable clinical outcomes in radical gallbladder excision. Unfortunately, most patients are ineligible for surgical intervention because of the advanced stage of the disease upon diagnosis. Consequently, non-surgical interventions, such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy, have become the mainstay of treatment for patients in advanced stages. This review focuses on elucidating various surgical techniques as well as advancements in immunotherapy and targeted therapy in the context of recent advancements in gallbladder cancer research.
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Affiliation(s)
- Yanjun Sun
- Department of General Surgery, The Armed Police Corps Hospital of Anhui, Hefei, China
| | - Junfeng Gong
- Department of General Surgery, The Armed Police Corps Hospital of Anhui, Hefei, China
| | | | - Lin Han
- Department of General Surgery, The Armed Police Corps Hospital of Anhui, Hefei, China
| | - Dengqun Sun
- Department of General Surgery, The Armed Police Corps Hospital of Anhui, Hefei, China
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15
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Wang Y, Peng J, Liu K, Sun P, Ma Y, Zeng J, Jiang Y, Tan B, Cao J, Hu W. Preoperative prediction model for non-neoplastic and benign neoplastic polyps of the gallbladder. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107930. [PMID: 38159390 DOI: 10.1016/j.ejso.2023.107930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians. METHODS We conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors. RESULTS Regression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = -5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872-0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection. CONCLUSION Age, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.
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Affiliation(s)
- Yubing Wang
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiechao Peng
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kui Liu
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peng Sun
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yonghui Ma
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiange Zeng
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yumin Jiang
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bin Tan
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jingyu Cao
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weiyu Hu
- Department of Hepatobiliary and Pancreas, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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16
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Kim NH, Kim HJ, Kang JH. Impact of hepatitis B virus infection on the risk of gallbladder polyps: a cohort study. Korean J Intern Med 2023; 38:844-853. [PMID: 37848340 PMCID: PMC10636554 DOI: 10.3904/kjim.2023.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND/AIMS We aimed to determine whether hepatitis B virus (HBV) or hepatitis C virus (HCV) infection remains an important risk factor for gallbladder polyps (GBPs) in the current context of reduced prevalence of these infections. METHODS The cohort included 392,913 asymptomatic adults who underwent abdominal ultrasonography (US). RESULTS The prevalence of GBP sized ≥ 5 mm, ≥ 10 mm, and overall (< 5, 5-9 and ≥ 10 mm) was 2.9%, 0.1%, and 12.8%, respectively. The prevalence of hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and hepatitis C antibody (anti-HCV) positivity was 3.2%, 26.7%, and 0.1%, respectively. The GBP risk was significantly increased in HBsAg-positive individuals, with an adjusted odds ratio of 1.66 (95% confidence interval, 1.49-1.85) for GBP ≥ 5 mm, 2.39 (1.53-3.75) for GBP ≥ 10 mm, and 1.49 (1.41-1.59) for overall, whereas there was no significant association between anti-HCV positivity and GBP risk. The GBP risk did not increase significantly in individuals who tested negative for HBsAg but positive for HBcAb. CONCLUSION The presence of HBsAg may be an independent risk factor for GBP development in the current context of a indecreasing prevalence of HBsAg positivity. A more comprehensive evaluation of GBP during abdominal US surveillance of HBsAg-positive individuals may be necessary.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hun Kang
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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17
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Kim NH, Kang JH, Kim HJ. Differences in the Impact of Obesity and Metabolic Unhealthiness on the Risk of Gallbladder Polyp. Yonsei Med J 2023; 64:658-664. [PMID: 37880846 PMCID: PMC10613762 DOI: 10.3349/ymj.2023.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Differences in the impact of obesity and metabolic health status on the risk of gallbladder polyp (GBP) remain uncertain. Herein, we aimed to compare the risk of GBP ≥5 mm among individuals with different phenotypes based on obesity and metabolic health status. MATERIALS AND METHODS A cohort of 253485 asymptomatic adults who underwent abdominal ultrasonography screening were categorized into the following four groups according to obesity and metabolic health status: 1) metabolically healthy non-obese (MHNO), 2) metabolically unhealthy and non-obese (MUNO), 3) metabolically healthy but obese (MHO), and 4) metabolically unhealthy obese (MUO). RESULTS The prevalences of GBP ≥5 mm were 2.4%, 3.1%, 3.7%, and 4.0% in the MHNO, MUNO, MHO, and MUO groups, respectively. The multivariable-adjusted odds ratio (OR) values for prevalence of GBP ≥5 mm by comparing the MUNO, MHO, and MUO with the MHNO group were 1.11 [95% confidence interval (CI), 1.04-1.19], 1.30 (95% CI, 1.15-1.47), and 1.37 (95% CI, 1.28-1.45), respectively. The risk of GBP ≥5 mm in the MHO group was significantly higher than that in the MUNO group, but not significantly different from that in the MUO group. CONCLUSION Obesity and metabolic unhealthiness appear to be independent risk factors for the prevalence of GBP, and the impact of obesity is greater than that of metabolic unhealthiness, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of GBP.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hun Kang
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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18
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Riddell ZC, Corallo C, Albazaz R, Foley KG. Gallbladder polyps and adenomyomatosis. Br J Radiol 2023; 96:20220115. [PMID: 35731858 PMCID: PMC9975534 DOI: 10.1259/bjr.20220115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Incidental findings are commonly detected during examination of the gallbladder. Differentiating benign from malignant lesions is critical because of the poor prognosis associated with gallbladder malignancy. Therefore, it is important that radiologists and sonographers are aware of common incidental gallbladder findings, which undoubtedly will continue to increase with growing medical imaging use. Ultrasound is the primary imaging modality used to examine the gallbladder and biliary tree, but contrast-enhanced ultrasound and MRI are increasingly used. This review article focuses on two common incidental findings in the gallbladder; adenomyomatosis and gallbladder polyps. The imaging features of these conditions will be reviewed and compared between radiological modalities, and the pathology, epidemiology, natural history, and management will be discussed.
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Affiliation(s)
- Zena C Riddell
- National Imaging Academy of Wales (NIAW), Bridgend, United Kingdom
| | - Carmelo Corallo
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England
| | - Raneem Albazaz
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, England
| | - Kieran G Foley
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
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19
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Dong C, Xian R, Wang G, Cui L. Small Intestinal Bacterial Overgrowth in Patients with Gallbladder Polyps: A Cross-Sectional Study. Int J Gen Med 2023; 16:813-822. [PMID: 36883124 PMCID: PMC9985880 DOI: 10.2147/ijgm.s399812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/01/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose There is probably a high prevalence of small intestinal bacterial overgrowth (SIBO) in patients with gallbladder polyps (GBPs). To date, no study has evaluated the occurrence of SIBO in patients with GBPs. The aim of this study was to investigate the prevalence of SIBO in patients with GBPs and explore the possible association between these two conditions. Patients and Methods The hydrogen-methane breath test was used to diagnose SIBO, and patients were divided into GBPs and control groups based on whether GBPs were found under ultrasound. Clinical and paraclinical factors were compared between the two groups. Results A total of 297 subjects were included in this study. The prevalence of SIBO was significantly higher in the GBPs group than in the control group (50.0% vs.30.8%, p<0.01). Multivariate logistic regression analysis showed that male (OR=2.26, 95% CI=1.12-4.57, p=0.023), SIBO (OR=3.21, 95% CI=1.69-6.11, p<0.001), fatty liver (OR=2.91, 95% CI= 1.50-5.64, p=0.002) and BMI (OR=1.13, 95% CI=1.01-1.26, p=0.035) were independently associated with GBPs. And by subgroup analysis, we found that the association between SIBO and GBPs was stronger in females than in males (p for interaction< 0.001). In addition, SIBO (OR=5.11, 95% CI=1.42-18.36, p=0.012) and fasting glucose (OR=3.04, 95% CI=1.27-7.28, p=0.013) were found to be associated with solitary polyps. Conclusion SIBO was highly prevalent in patients with GBPs, and this association seemed to be stronger among females.
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Affiliation(s)
- Changhao Dong
- Department of Gastroenterology, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China.,Department of Gastroenterology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, People's Republic of China
| | - Rui Xian
- Department of Gastroenterology, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China.,Department of Gastroenterology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, People's Republic of China
| | - Guangxiang Wang
- Department of Gastroenterology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, People's Republic of China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Lihong Cui
- Department of Gastroenterology, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China.,Department of Gastroenterology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, People's Republic of China
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20
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Li Q, Zhang J, Cai Z, Jia P, Wang X, Geng X, Zhang Y, Lei D, Li J, Yang W, Yang R, Zhang X, Yang C, Yao C, Hao Q, Liu Y, Guo Z, Si S, Geng Z, Zhang D. A Bayesian network prediction model for gallbladder polyps with malignant potential based on preoperative ultrasound. Surg Endosc 2023; 37:518-527. [PMID: 36002683 DOI: 10.1007/s00464-022-09532-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is important to identify gallbladder polyps (GPs) with malignant potential and avoid unnecessary cholecystectomy by constructing prediction model. The aim of the study is to develop a Bayesian network (BN) prediction model for GPs with malignant potential in a long diameter of 8-15 mm based on preoperative ultrasound. METHODS The independent risk factors for GPs with malignant potential were screened by χ2 test and Logistic regression model. Prediction model was established and validated using data from 1296 patients with GPs who underwent cholecystectomy from January 2015 to December 2019 at 11 tertiary hospitals in China. A BN model was established based on the independent risk variables. RESULTS Independent risk factors for GPs with malignant potential included age, number of polyps, polyp size (long diameter), polyp size (short diameter), and fundus. The BN prediction model identified relationships between polyp size (long diameter) and three other variables [polyp size (short diameter), fundus and number of polyps]. Each variable was assigned scores under different status and the probabilities of GPs with malignant potential were classified as [0-0.2), [0.2-0.5), [0.5-0.8) and [0.8-1] according to the total points of [- 337, - 234], [- 197, - 145], [- 123, - 108], and [- 62,500], respectively. The AUC was 77.38% and 75.13%, and the model accuracy was 75.58% and 80.47% for the BN model in the training set and testing set, respectively. CONCLUSION A BN prediction model was accurate and practical for predicting GPs with malignant potential patients in a long diameter of 8-15 mm undergoing cholecystectomy based on preoperative ultrasound.
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Affiliation(s)
- Qi Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jingwei Zhang
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China
| | - Zhiqiang Cai
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China
| | - Pengbo Jia
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, 712000, Shaanxi, China
| | - Xintuan Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, 712000, Shaanxi, China
| | - Xilin Geng
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Da Lei
- Department of Hepatobiliary Surgery, Central Hospital of Baoji City, Baoji, 721000, Shaanxi, China
| | - Junhui Li
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Wenbin Yang
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Rui Yang
- Department of Hepatobiliary Surgery, Central Hospital of Hanzhong City, Hanzhong, 723000, Shaanxi, China
| | - Xiaodi Zhang
- Department of General Surgery, No. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, 712000, Shaanxi, China
| | - Chenglin Yang
- Department of General Surgery, Central Hospital of Ankang City, Ankang, 725000, Shaanxi, China
| | - Chunhe Yao
- Department of General Surgery, Xianyang Hospital of Yan'an University, Xianyang, 712000, Shaanxi, China
| | - Qiwei Hao
- Department of Hepatobiliary Surgery, The Second Hospital of Yulin City, Yulin, 719000, Shaanxi, China
| | - Yimin Liu
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, 721000, Shaanxi, China
| | - Zhihua Guo
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, 721000, Shaanxi, China
| | - Shubin Si
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China
| | - Zhimin Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Dong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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21
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Malik DG, Dahiya N, Lubner MG, Pickhardt PJ, Elsayes KM, Robinson KA, Menias CO. Spectrum of imaging findings in hyperplastic cholecystosis and potential mimics. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:47-62. [PMID: 36183294 DOI: 10.1007/s00261-022-03680-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023]
Abstract
Adenomyomatosis and cholesterolosis of the gallbladder, collectively termed hyperplastic cholecystosis, are commonly encountered incidental findings on imaging studies performed for a variety of indications including biliary colic or nonspecific abdominal pain. These pathologies are rarely the source of symptoms, generally considered benign and do not require further work-up. However, their imaging characteristics can overlap with more sinister conditions that should not be missed. In this review, the imaging findings of adenomyomatosis and cholesterolosis will be reviewed followed by other gallbladder pathologies that might mimic these conditions radiologically. Important differentiating factors will be discussed that can aid the radiologist in making a more confident imaging diagnosis.
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Affiliation(s)
- Dania G Malik
- Department of Radiology, Mayo Clinic Arizona, Arizona, USA.
| | | | - Meghan G Lubner
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, USA
| | - P J Pickhardt
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, USA
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22
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Li Q, Xu S, Yuan Z, Zhang Y, Lu Q, Qian L, Xu J, Song Y, Zhao L, Chen T. Combining polyp diameter and polyp-to-bile ratio by dynamic contrast-enhanced CT scanning can improve the diagnostic specificity of gallbladder neoplastic polyps. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [PMID: 36528866 DOI: 10.1002/jhbp.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to distinguish between cholesterol and neoplastic gallbladder polyps using dynamic contrast-enhanced CT. METHODS The dataset retrospectively comprised 222 cases, including 106 cases of cholesterol polyps and 116 cases of neoplastic polyps (59 adenoma and 57 adenocarcinoma). The perception and Hounsfield units of the polyps and gallbladder bile were assessed by contrast-enhanced CT, and the polyp-to-bile ratio (PBR) was calculated. Receiver operating characteristic (ROC) curves and area under the curve analyses were used to assess the diagnostic value of the diameter and PBR for neoplastic polyps. RESULTS The diameter of cholesterol polyps was significantly smaller than that of neoplastic polyps. The proportion of perceived cholesterol polyps in the plain and arterial phases of CT were significantly lower than those of neoplastic polyps (p < .001). On the contrary, the CT values of gallbladder bile of cholesterol polyps were always significantly higher than those of neoplastic polyps (p < .001). The median PBR values of cholesterol polyps were significantly lower than those of neoplastic polyps (p ≤ .001). ROC analysis showed that diameter and a plain phase PRB had better diagnostic value for neoplastic polyps. Polyp diameter ≥ 11.95 mm and the plain phase PBR ≥1.48 were the optimal cut-off values for diagnosis of neoplastic polyps. Combining a diameter ≥ 12 mm and a PBR in the plain phase ≥1.48 further improved neoplastic polyp diagnostic specificity and positive likelihood ratio (10.453). CONCLUSIONS Polyp-to-bile ratio in contrast-enhanced CT scanning is a new and convenient index for identifying cholesterol and neoplastic gallbladder polyps.
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Affiliation(s)
- Qiwei Li
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sunwang Xu
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Yuan
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yunhe Zhang
- Department of Critical Care Medicine, Shanghai East Hospital, Tongji University of School Medicine, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lijun Qian
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanyan Song
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhao
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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23
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Jenssen C, Lorentzen T, Dietrich CF, Lee JY, Chaubal N, Choi BI, Rosenberg J, Gutt C, Nolsøe CP. Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2355-2378. [PMID: 36058799 DOI: 10.1016/j.ultrasmedbio.2022.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings with a series of position papers to give advice on characterization and management. The biliary system (gallbladder and biliary tree) is the third most frequent site for incidental findings. This first part of the position paper on incidental findings of the biliary system is related to general aspects, gallbladder polyps and other incidental findings of the gallbladder wall. Available evidence on prevalence, diagnostic work-up, malignancy risk, follow-up and treatment is summarized with a special focus on ultrasound techniques. Multiparametric ultrasound features of gallbladder polyps and other incidentally detected gallbladder wall pathologies are described, and their inclusion in assessment of malignancy risk and decision- making on further management is suggested.
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Affiliation(s)
- Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/Wriezen, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
| | - Jae Young Lee
- Department of Radiology, Medical Research Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Buyng Ihn Choi
- Department of Radiology, Medical Research Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Carsten Gutt
- Department of Surgery, Klinikum Memmingen, Memmingen, Germany
| | - Christian P Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
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24
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Liu J, Qian Y, Yang F, Huang S, Chen G, Yu J, Jiang S, Huang G. Value of prediction model in distinguishing gallbladder adenoma from cholesterol polyp. J Gastroenterol Hepatol 2022; 37:1893-1900. [PMID: 35750491 DOI: 10.1111/jgh.15928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM 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. METHODS 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. RESULTS 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 (10 mm) 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 10 mm as the optimal diagnostic cutoff value to diagnose adenomas were 74.8% and 65.9%, respectively. CONCLUSIONS 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.
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Affiliation(s)
- Jiandong Liu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Youwen Qian
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Feng Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Sunhua Huang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Gang Chen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Jian Yu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
| | - Shanshan Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Gang Huang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China
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25
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Han JW, Choi YH, Lee IS, Choi HJ, Hong TH, You YK. Gallbladder polyps growth rate is an independent risk factor for neoplastic polyps. United European Gastroenterol J 2022; 10:651-656. [PMID: 36087036 PMCID: PMC9486499 DOI: 10.1002/ueg2.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The size of gallbladder (GB) polyps is a representative risk factor for neoplastic polyps. However, whether growth rate during follow‐up is associated with neoplastic polyps remains unclear. Methods From 2009 to 2019, a cohort of patients with GB polyps who underwent cholecystectomy was enrolled. We included only patients who underwent at least two abdominal ultrasonography procedures at least 6 months apart prior to cholecystectomy. Performance and optimal cutoff value of polyp growth rate for predicting neoplastic polyps were estimated using receiver operating characteristic (ROC) analysis. In addition to growth rate, several other variables considered suitable for predicting neoplastic polyps were also investigated. A nomogram was created to predict neoplastic polyps. Results A total of 239 patients with neoplastic polyps (n = 27, 11.3%) and non‐neoplastic polyps (n = 212, 88.7%) were included. The median follow‐up period was 28.5 months. The area under the ROC curve (AUROC) of polyp growth rate for neoplastic polyps was 0.66 (95% confidence interval, 0.59–0.72). The growth rate cutoff value for prediction of neoplastic polyps was 3 mm/year (sensitivity, 37.0%; specificity, 86.3%). Multivariate analysis identified several factors predicting neoplastic polyps: polyp size ≥10 mm (odds ratio [OR], 3.74, p = 0.041), solitary polyp (OR, 3.92, p = 0.004), and polyp growth rate ≥ 3 mm/year (OR, 2.75, p = 0.031). The AUROC of the nomogram using these three significant factors in multivariate analysis was 0.71. Conclusion GB polyps with a growth rate of over 3 mm per year on ultrasonography during follow‐up should be considered a risk factor for neoplastic polyps.
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Affiliation(s)
- Ji Won Han
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hoon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoung You
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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26
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A New Risk Scoring System to Predict Malignancy in Gallbladder Polyps: a Single-Center Study. J Gastrointest Surg 2022; 26:1846-1852. [PMID: 35581462 DOI: 10.1007/s11605-022-05351-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/30/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Ultrasonography (US) is the most commonly used radiological method in the diagnosis of gallbladder polyps (GBPs). Patients diagnosed with GBPs on US are operated on with risk factors that do not have a high level of evidence. Our aim in this study is to determine the sensitivity of US in diagnosis GBPs, to define risk factors for neoplastic (NP) polyps, and to develop the risk scoring system. MATERIALS AND METHODS Between July 2011 and July 2021, 173 patients who were found to have GBPs in the pathology specimens after cholecystectomy were included in the study. Patients were divided into two groups: nonneoplastic and NP groups. RESULTS GBPs in patients who underwent abdominal US for any reason was 4.5%. The sensitivity of US in the diagnosis of GBPs was 56.6%. Comparison between groups, age ≥50, presence of symptoms, polyp size >12.5mm, single polyp, concomitant gallstones, and gallbladder wall thickness ≥4mm were statistically in the NP group. A risk scoring system was developed using these values. If the risk score was <4, 0.6% of GBPs was NP polyps. If the risk score was ≥4, 63.2% of GBPs were NP polyps. CONCLUSION Our risk scoring system can prevent unnecessary choelcystectomy. Because the incidence of NP polyps in low-risk patients (risk score <4) is extremely rare.
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27
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Foley KG, Riddell Z, Coles B, Roberts SA, Willis BH. Risk of developing gallbladder cancer in patients with gallbladder polyps detected on transabdominal ultrasound: a systematic review and meta-analysis. Br J Radiol 2022; 95:20220152. [PMID: 35819918 PMCID: PMC10996949 DOI: 10.1259/bjr.20220152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/14/2022] [Accepted: 07/06/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To estimate the risk of malignancy in gallbladder polyps of incremental sizes detected during transabdominal ultrasound (TAUS). METHODS We searched databases including MEDLINE, Embase, and Cochrane Library for eligible studies recording the polyp size from which gallbladder malignancy developed, confirmed following cholecystectomy, or by subsequent follow-up. Primary outcome was the risk of gallbladder cancer in patients with polyps. Secondary outcome was the effect of polyp size as a prognostic factor for cancer. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Bayesian meta-analysis estimated the median cancer risk according to polyp size. This study is registered with PROSPERO (CRD42020223629). RESULTS 82 studies published since 1990 reported primary data for 67,837 patients. 67,774 gallbladder polyps and 889 cancers were reported. The cumulative median cancer risk of a polyp measuring 10 mm or less was 0.60% (99% credible range 0.30-1.16%). Substantial heterogeneity existed between studies (I2 = 99.95%, 95% credible interval 99.86-99.98%). Risk of bias was generally high and overall confidence in evidence was low. 13 studies (15.6%) were graded with very low certainty, 56 studies (68.3%) with low certainty, and 13 studies (15.6%) with moderate certainty. In studies considered moderate quality, TAUS monitoring detected 4.6 cancers per 10,000 patients with polyps less than 10 mm. CONCLUSION Malignant risk in gallbladder polyps is low, particularly in polyps less than 10 mm, however the data are heterogenous and generally low quality. International guidelines, which have not previously modelled size data, should be informed by these findings. ADVANCES IN KNOWLEDGE This large systematic review and meta-analysis has shown that the mean cumulative risk of small gallbladder polyps is low, but heterogeneity and missing data in larger polyp sizes (>10 mm) means the risk is uncertain and may be higher than estimated.Studies considered to have better methodological quality suggest that previous estimates of risk are likely to be inflated.
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Affiliation(s)
- Kieran G Foley
- Division of Cancer & Genetics, School of Medicine, Cardiff
University, Cardiff,
UK
| | - Zena Riddell
- National Imaging Academy of Wales (NIAW),
Pencoed, UK
| | - Bernadette Coles
- Velindre University NHS Trust Library & Knowledge
Service, Cardiff,
UK
| | - S Ashley Roberts
- Department of Clinical Radiology, University Hospital of
Wales, Cardiff,
UK
| | - Brian H Willis
- Institute of Applied Health Research, University of
Birmingham, Birmingham,
UK
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28
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Kamaya A, Fung C, Szpakowski JL, Fetzer DT, Walsh AJ, Alimi Y, Bingham DB, Corwin MT, Dahiya N, Gabriel H, Park WG, Porembka MR, Rodgers SK, Tublin ME, Yuan X, Zhang Y, Middleton WD. Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2022; 305:277-289. [PMID: 35787200 DOI: 10.1148/radiol.213079] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Aya Kamaya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Christopher Fung
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Jean-Luc Szpakowski
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David T Fetzer
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Andrew J Walsh
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yewande Alimi
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David B Bingham
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Michael T Corwin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Helena Gabriel
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Walter G Park
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Matthew R Porembka
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Shuchi K Rodgers
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Mitchell E Tublin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Xin Yuan
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yang Zhang
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - William D Middleton
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
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Ghartimagar D, Shrestha MK, Ruwanpathirana RE, Purbe D, Mishra S. Incidental finding of a large polypoidal gallbladder mass diagnosed as papillary adenocarcinoma – A case report. Int J Surg Case Rep 2022; 94:107046. [PMID: 35421724 PMCID: PMC9019258 DOI: 10.1016/j.ijscr.2022.107046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion
Polypoid lesions of gallbladder are discovered incidentally. Presenting symptoms are mostly nonspecific. Ultrasonography of abdomen on routine health check-up showed the lesion. Most of the lesions are benign in nature but few present with malignant features. Polyps larger than 1 cm in size have higher chance of malignancy.
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Affiliation(s)
- Dilasma Ghartimagar
- Department of Pathology, Manipal College of Medical Science, Pokhara, Nepal.
| | | | | | - Dipika Purbe
- Department of Pathology, Manipal College of Medical Science, Pokhara, Nepal
| | - Sushil Mishra
- Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal
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Prieto-Ortiz RG, Borráez-Segura BA, Prieto-Ortiz JE, Guevara-Cruz ÓA. Cáncer de vesícula biliar, una visión actual. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El diagnóstico de cáncer de vesícula biliar se realiza generalmente de forma incidental durante el estudio de las piezas quirúrgicas o cuando la enfermedad está avanzada y se expresa por su diseminación. Muy pocas veces se diagnostica de forma preoperatoria. Corresponde a la neoplasia más común de las vías biliares y su incidencia varía de acuerdo a la región geográfica. La región andina en Latinoamérica presenta una de las mayores incidencias a nivel mundial.
Métodos. Se realizó una revisión narrativa de la literatura, para presentar una información actualizada en lo referente a los factores de riesgo (incluyendo las alteraciones genéticas y moleculares), al diagnóstico y al tratamiento de esta patología. Basados en los datos actuales, presentamos algunas recomendaciones dirigidas al diagnóstico temprano, que permita un manejo más adecuado de nuestros pacientes.
Resultados. Se han implicado nuevos factores de riesgo relacionados con la etiología del cáncer de vesícula biliar, como la obesidad, factores genéticos y moleculares. A pesar de la disponibilidad de los métodos diagnósticos imagenológicos, no ha ocurrido una importante variación porcentual en cuanto al estadio al momento del diagnóstico.
Conclusiones. El manejo quirúrgico del cáncer de vesícula biliar está indicado en los estadios más tempranos de la enfermedad y es importante evaluar las opciones terapéuticas en pacientes con enfermedad avanzada. Se considera de suma importancia el estudio anatomopatológico de la pieza quirúrgica y la revisión del informe por parte del cirujano
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Fosio M, Cherobin G, Stramare R, Fassan M, Giraudo C. Coronary Artery Disease and Gallbladder Inflammatory Pseudopolyps. Diagnostics (Basel) 2022; 12:155. [PMID: 35054322 PMCID: PMC8774625 DOI: 10.3390/diagnostics12010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
Axial MR image demonstrating multiple small gallbladder polypoid lesions characterized by contrast enhancement in a 78-year-old male hospitalized for acute chest pain due to coronary artery disease who showed fever and emesis during hospitalization and had signs of acute acalculous cholecystitis at computed tomography. Given the overall clinical conditions and the MR features, the inflammatory origin of the polyps was considered. The patient underwent cholecystectomy and the histological diagnosis of gallbladder inflammatory pseudopolyps was confirmed. This rare entity represents 5-10% of all gallbladder polyps, and their differentiation from benign and malignant tumors might be challenging especially in acalculous patients, thus surgery is often performed.
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Affiliation(s)
- Margherita Fosio
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Giulia Cherobin
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Roberto Stramare
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
| | - Matteo Fassan
- Surgical Pathology, Department of Medicine, University of Padova, 35121 Padova, Italy;
- Veneto Institute of Oncology, IOV-IRCCS, 35128 Padova, Italy
| | - Chiara Giraudo
- UOSD Imaging Avanzato Clinico e Translazionale, Department of Medicine, University of Padova, 35127 Padova, Italy; (M.F.); (G.C.); (R.S.)
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Naito S, Noritomi T, Fukuda Y, Goto Y, Hieda T, Hasegawa S. Papillary hyperplasia of the gallbladder diagnosed as gallbladder cancer before surgery: A case report. Int J Surg Case Rep 2021; 88:106542. [PMID: 34741864 PMCID: PMC8581500 DOI: 10.1016/j.ijscr.2021.106542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Gallbladder cancer has a poor prognosis. Therefore, an accurate diagnosis is required, for which various tests are performed. However, in some cases, it is difficult to distinguish between benign and malignant diseases before surgery. Papillary hyperplasia of the gallbladder is known for its secondary changes. Papillary hyperplasia of the gallbladder, which is known for its secondary changes, is a benign disease. We encountered papillary hyperplasia of the gallbladder with morphological changes over the course of 1 year. In addition, the tumor was suggested to be malignant during various examinations. We present a case of papillary hyperplasia of the gallbladder showing an increasing tendency and findings indicative of malignancy on imaging. Presentation of case A 70-year-old man underwent routine abdominal ultrasonography every year. We observed that the gallbladder wall was thickened. The tumor size was 24 mm. FDG-PET and other examinations indicated malignancy requiring surgery. Clinical discussion Accurate diagnosis of gallbladder tumor is difficult only by diagnostic imaging. There are problems with preoperative cytology and histology. FS can be an important test to avoid extended surgery. Conclusion We report a rare case of papillary hyperplasia of the gallbladder, which was difficult to diagnose. Even when morphological changes and imaging findings suggest malignancy, similar findings could appear in papillary hyperplasia of the gallbladder owing to chronic inflammation.
Gallbladder cancer has a poor prognosis. It is difficult to distinguish between benign diseases before surgery. Papillary hyperplasia of the gallbladder shows secondary changes. Papillary hyperplasia of the gallbladder can be confused for a malignancy.
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Affiliation(s)
- Shigetoshi Naito
- Department of Surgery, Fukuoka Tokushukai Hospital, Fukuoka, Japan; Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Tomoaki Noritomi
- Department of Surgery, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | - Yoshihisa Fukuda
- Department of Gastroenterology, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | - Yuko Goto
- Department of Pathology, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | - Takuro Hieda
- Department of Surgery, Fukuoka Tokushukai Hospital, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Ali TA, Abougazia AS, Alnuaimi AS, Mohammed MAM. Prevalence and risk factors of gallbladder polyps in primary health care centers among patients examined by abdominal ultrasonography in Qatar: a case-control study. Qatar Med J 2021; 2021:48. [PMID: 34660216 PMCID: PMC8501236 DOI: 10.5339/qmj.2021.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gallbladder (GB) polyps are raised lesions from the GB wall and projected into its lumen. The prevalence of GB polyps ranged between 4.3% and 12.3%. The clinical presentation of GB polypoid lesions vary, can be nonspecific and vague, and may be asymptomatic. Identifying malignant and premalignant polyps is important to provide treatment early and prevent cancer spread or development of malignancy. Ultrasonography (US) is the first imaging modality widely used in abdominal imaging. It is a noninvasive, rapid, painless, and safe imaging technique, with no radiation; thus, it is considered the best available examination with good sensitivity and specificity for GB polyps. AIM OF THE WORK This study aimed to determine the relative frequency of the GB polyps and its risk factors among patients who underwent abdominal US in Primary Health Care Corporation, Qatar. MATERIALS AND METHODS This was quantitative multicenter observational case-control study nested in a cross-sectional design. For the cross-sectional top-level study, the first step was to assess available abdominal ultrasound studies for the presence of GB polyps and stones. The second step was to perform a case-control study with three groups (a case group and two control groups; first, participants without GB stones and GB polyps; second, patients with GB stones but without GB polyps). RESULTS The study evaluated the GB images of 7156 individuals. The overall prevalence of GB polyps was 7.4% in the study population. Specifically, the overall prevalence of solitary GB polyp was 4.2% and that of multiple GB polyps was 3.2%. Regarding the size distribution of GB polyps in positive cases, 89.4% were < 6 mm, 9.3% were 69 mm, and 1.3% were ≥ 10 mm. Prevalence rate of selected comorbidities were as follows: liver disease, 1.8%; diabetes mellitus, 25.5%; hypertension, 25.5%; and dyslipidemia, 29.8%. The prevalence in male and female patients was 7.7% and 7%, respectively. The prevalence of GB polyps was higher in south-eastern patients (21.4% of positive cases) and was the highest in the overweight group (8.8%). A higher prevalence was noted in the hypertensive group (hypertensive group, 9.8%; non-hypertensive group, 6.6%) and dyslipidemia group (dyslipidemia group, 7.8%; no dyslipidemia group, 7.2%). Moreover, a higher prevalence was noted in hepatitis B surface (HBS)-positive group (15%) than in the HBS-negative group (8.2%) and slightly higher in Helicobacter pylori antigen positive group than in the negative group. CONCLUSION Abdominal US is an important and commonly used imaging modality in the detection of GB polyps. In this study, the prevalence of GB polyps was approximately 7.4%, with higher prevalence in participants who were overweight and had diabetes mellitus, hypertension, and dyslipidemia.
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Affiliation(s)
- Tamer A Ali
- Radiology Department, PHCC, Doha, Qatar E-mail:
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Diep R, Lombardo P, Schneider M. The growth rates of solitary gallbladder polyps compared to multi‐polyps: A quantitative analysis. Australas J Ultrasound Med 2021; 25:28-35. [DOI: 10.1002/ajum.12284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Raymond Diep
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Paul Lombardo
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences Monash University Clayton Victoria Australia
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Fei X, Li N, Zhu L, Han P, Jiang B, Tang W, Sang M, Zhang X, Luo Y. Value of high frame rate contrast-enhanced ultrasound in distinguishing gallbladder adenoma from cholesterol polyp lesion. Eur Radiol 2021; 31:6717-6725. [PMID: 33569621 DOI: 10.1007/s00330-021-07730-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/10/2020] [Accepted: 01/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. KEY POINTS • 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.
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Affiliation(s)
- Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lianhua Zhu
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Peng Han
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bo Jiang
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wenbo Tang
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Maodong Sang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nanshan District, Shenzhen, 518055, China
| | - Xirui Zhang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nanshan District, Shenzhen, 518055, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China.
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Jang SI, Cho JH, Lee DK. [Recent Updates on Diagnosis, Treatment, and Follow-up of Gallbladder Polyps]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 76:102-107. [PMID: 32969359 DOI: 10.4166/kjg.2020.76.3.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/15/2020] [Accepted: 08/15/2020] [Indexed: 01/28/2023]
Abstract
A gallbladder (GB) polyp is an elevation of the GB mucosa that protrudes into the GB lumen. GB polyps have an estimated prevalence of 0.3-9.5% and can be divided into neoplastic (true) polyps and nonneoplastic polyps (pseudopolyps). Pseudopolyps are most commonly cholesterol polyps but also include focal adenomyomatosis and inflammatory polyps with no malignant potential. Neoplastic polyps, however, can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are usually adenocarcinoma. Transabdominal ultrasonography is the main radiological modality used for diagnosing and surveilling GB polyps. On the other hand, because it is difficult to diagnose GB polyps before surgery, alternative imaging modalities, such as endoscopic ultrasound, are being further evaluated. The current guidelines recommend cholecystectomy for GB polyps ≥ 10 mm in size as well as suboptimal sized GB polyps (6-9 mm) with other risk factors, including age >50, sessile, and symptoms. The quality of the evidence behind this practice is relatively low. Therefore, this review identifies the current gaps in the available evidence and guidelines and introduces methods that can help make decisions regarding patients who require a cholecystectomy or follow-up.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Zhang D, Li Q, Zhang X, Jia P, Wang X, Geng X, Zhang Y, Li J, Yao C, Liu Y, Guo Z, Yang R, Lei D, Yang C, Hao Q, Yang W, Geng Z. Establishment of a nomogram prediction model for long diameter 10-15 mm gallbladder polyps with malignant tendency. Surgery 2021; 170:664-672. [PMID: 34090677 DOI: 10.1016/j.surg.2021.04.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical indications for the treatment of gallbladder polyps are controversial. Evaluation of gallbladder polyps with malignant tendency and indications for cholecystectomy in patients with long diameter polyps of 10 to 15 mm require further analysis and discussion. In this study, our objective was to re-evaluate indications for the surgical resection of gallbladder polyps and construct a nomogram model for the prediction of gallbladder polyps with malignant tendency. METHODS Clinicopathologic data of 2,272 patients who had undergone cholecystectomy for gallbladder polyps were collected from 11 medical centers in China. Risk factor analyses and nomogram prediction model for gallbladder polyps with malignant tendency were conducted. RESULTS Excluding 311 patients with cholelithiasis and 488 patients with long diameter polyps ≤5 and >15 mm, factors that differed significantly among patients with gallbladder polyps having a long diameter of 6 to 9 mm (885 cases) and 10 to 15 mm (588 cases) were polyp detection time, CEA and CA19-9 levels, number of polyps, fundus, echogenicity, gallbladder wall thickness and postoperative pathologic features (P < .05). Among 588 patients with gallbladder polyps with a long diameter of 10 of 15 mm, multivariate analysis indicated the following independent risk factors of gallbladder polyps with malignant tendency: single polyps (OR = 0.286/P < .001), polyps with broad base (OR = 2.644/P = .001), polyps with medium/low echogenicity (OR = 2.387/P = .003), and polyps with short diameter of 7 to 9 or 10 to 15 mm (OR = 3.820/P = .005; OR = 2.220/P = .048, respectively). The C-index of the nomogram model and internal validation were .778 and .768, respectively. In addition, a sample online calculator for the nomogram prediction model had been created (https://docliqi.shinyapps.io/dynnom/). CONCLUSION Indications for cholecystectomy in patients with gallbladder polyps with a long diameter of 10 to 15 mm should be assessed by combining the information on short diameter, number of polyps, fundus, and echogenicity. The nomogram model can be used to predict the risk for the development of gallbladder polyps with malignant tendency.
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Affiliation(s)
- Dong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaodi Zhang
- Department of Hepatobiliary Surgery, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Pengbo Jia
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, China
| | - Xintuan Wang
- Department of Hepatobiliary Surgery, The First People's Hospital of Xianyang City, Xianyang, China
| | - Xilin Geng
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Junhui Li
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chunhe Yao
- Department of General Surgery, Xianyang Hospital of Yan'an University, Xianyang, China
| | - Yimin Liu
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, China
| | - Zhihua Guo
- Department of Hepatobiliary Surgery, People's Hospital of Baoji City, Baoji, China
| | - Rui Yang
- Department of General Surgery, Central Hospital of Hanzhong City, Hanzhong, China
| | - Da Lei
- Department of Hepatobiliary Surgery, Central Hospital of Baoji City, Baoji, China
| | - Chenglin Yang
- Department of General Surgery, Central Hospital of Ankang City, Ankang, China
| | - Qiwei Hao
- Department of Hepatobiliary Surgery, The Second Hospital of Yulin City, Yulin, China
| | - Wenbin Yang
- Department of General Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhimin Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Akbulut S, Sahin TT. Comment on gallbladder polyps: Correlation of size and clinicopathologic characteristics based on updated definitions. Int J Surg Case Rep 2021; 83:105947. [PMID: 34015684 PMCID: PMC8141456 DOI: 10.1016/j.ijscr.2021.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/25/2021] [Indexed: 02/07/2023] Open
Abstract
• There was strong correlation between polyp diameter (≥ 10 mm vs <10 mm) and the risk of gallbladder cancer (OR=54; r=0.704). • There was moderate correlation between polyp diameter (10-19 mm vs <10 mm) and the risk of gallbladder cancer (OR=23; r=0.534). • There was moderate correlation between polyp diameter (≥ 20 mm vs <20 mm) and the risk of gallbladder cancer (OR=300; r=0.559). • There was moderate correlation between polyp diameter (≥ 20 mm vs <10 mm) and the risk of gallbladder cancer (OR=551; r=0.697). • Our results suggest that as the diameter of the polyp reaches 20 mm, it is necessary to plan a surgical treatment strategy as if the patient has gallbladder cancer.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University, Faculty of Medicine, 244280, Malatya, Turkey.
| | - Tevfik Tolga Sahin
- Department of Surgery and Liver Transplant Institute, Inonu University, Faculty of Medicine, 244280, Malatya, Turkey.
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Gautam A, Pandey A, Masood S, Chauhan S, Choudhary D, Kumar S, Madhawan S, Jha S, Saini V. Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population. Malays J Med Sci 2021; 28:27-34. [PMID: 33679217 PMCID: PMC7909354 DOI: 10.21315/mjms2021.28.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Gallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population. Methods A retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used. Results Of 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031). Conclusion Cholecystectomy needs to be considered early in the management of small-sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.
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Affiliation(s)
- Abhishek Gautam
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshuman Pandey
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shakeel Masood
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Smita Chauhan
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinesh Choudhary
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Suneed Kumar
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shibumon Madhawan
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sneha Jha
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vijay Saini
- Department of Surgical Gastroenterology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Onuchina EV. [Gallbladder polyps: modern approaches to diagnostics and treatment]. TERAPEVT ARKH 2021; 93:100-107. [PMID: 33720634 DOI: 10.26442/00403660.2021.01.200544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- E V Onuchina
- Irkutsk State Academy of Postgraduate Education - a branch of the Russian Medical Academy of Continuous Professional Education
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Lee T, Teng TZJ, Shelat VG. Carbohydrate antigen 19-9 - tumor marker: Past, present, and future. World J Gastrointest Surg 2020; 12:468-490. [PMID: 33437400 PMCID: PMC7769746 DOI: 10.4240/wjgs.v12.i12.468] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023] Open
Abstract
Carbohydrate antigen 19-9 (CA 19-9) is a cell surface glycoprotein complex most commonly associated with pancreatic ductal adenocarcinoma (PDAC). Koprowski first described it in 1979 using a mouse monoclonal antibody in a colorectal carcinoma cell line. Historically, it is one of the most commonly used tumor markers for diagnosing, managing, and prognosticating PDAC. Additionally, elevated CA 19-9 levels are used as an indication for surgery in suspected benign pancreatic conditions. Another common application of CA 19-9 in the biliary tract includes its use as an adjunct in diagnosing cholangiocarcinoma. However, its clinical value is not limited to the hepatopancreatobiliary system. The reality is that the advancing literature has broadened the clinical value of CA 19-9. The potential value of CA 19-9 in patients' workup extends its reach to gastrointestinal cancers - such as colorectal and oesophageal cancer - and further beyond the gastrointestinal tract - including urological, gynecological, pulmonary, and thyroid pathologies. Apart from its role in investigations, CA 19-9 presents a potential therapeutic target in PDAC and acute pancreatitis. In a bid to consolidate its broad utility, we appraised and reviewed the biomarker's current utility and limitations in investigations and management, while discussing the potential applications for CA 19-9 in the works for the future.
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Affiliation(s)
- Tsinrong Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Thomas Zheng Jie Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Vishal G Shelat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Kim KH. Gallbladder polyps: evolving approach to the diagnosis and management. Yeungnam Univ J Med 2020; 38:1-9. [PMID: 33045805 PMCID: PMC7787897 DOI: 10.12701/yujm.2020.00213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Gallbladder (GB) polyp is a mucosal projection into the GB lumen. With increasing health awareness, GB polyps are frequently found using ultrasonography during health screening. The prevalence of GB polyps ranges between 1.3% and 9.5%. Most patients are asymptomatic and have benign characteristics. Of the nonneoplastic polyps, cholesterol polyps are most common, accounting for 60%-70% of lesions. However, a few polyps have malignant potential. Currently, the guidelines recommend laparoscopic cholecystectomy for polyps larger than 1 cm in diameter due to their malignan potential. The treatment algorithm can be influenced by the size, shape, and numbers of polyps, old age (>50 years), the presence of primary sclerosing cholangitis, and gallstones. This review summarizes the commonly recognized concepts on GB polyps from diagnosis to an algorithm of treatment.
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Affiliation(s)
- Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Abstract
SummaryA gallbladder polyp (GP) is defined as an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen. Gallbladder polyps (GPs) have an estimated prevalence in adults of 0.3–12.3%. However, only 5% of polyps are considered “true” GPs that have malignant potential or are even already cancerous. The most important imaging method for diagnosis and follow-up of GPs is transabdominal ultrasound, but it fails to discriminate between true and pseudo polyps at a clinically relevant level. Although gallbladder cancer (GBC) arising from polyps is a rare event, malignancy is significantly more common among polyps from a size of 10 mm. In light of this, the consensus, which is reflected in current guidelines, is that surgery should be considered for polyps of 10 mm or greater. However, 10 mm is an arbitrary cutoff, and high-quality evidence to support this is lacking. Lowering the threshold for cholecystectomy when patients have additional risk factors for gallbladder malignancy may improve the cancer detection rate in polyps smaller than 10 mm. Nevertheless, the evidence behind this is also weak. This review shows the shortcomings in the available evidence and underlines the decision-making process regarding the surgical indication, surveillance, or both.
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Valibouze C, El Amrani M, Truant S, Leroy C, Millet G, Pruvot FR, Zerbib P. The management of gallbladder polyps. J Visc Surg 2020; 157:410-417. [PMID: 32473822 DOI: 10.1016/j.jviscsurg.2020.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neoplastic gallbladder polyps (NGP) are rare; the prevalence in the overall population is less than 10%. NGP are associated with a risk of malignant degeneration and must be distinguished from other benign gallbladder polypoid lesions that occur more frequently. NGP are adenomas and the main risk associated with their management is to fail to detect their progression to gallbladder cancer, which is associated with a particular poor prognosis. The conclusions of the recent European recommendations have a low level of evidence, based essentially on retrospective small-volume studies. Abdominal sonography is the first line study for diagnosis and follow-up for NGP. To prevent the onset of gallbladder cancer, or treat malignant degeneration in its early phases, all NGP larger than 10mm, or symptomatic, or larger than 6mm with associated risk factors for cancer (age over 50, sessile polyp, Indian ethnicity, or patient with primary sclerosing cholangitis) are indications for cholecystectomy. Apart from these situations, simple sonographic surveillance is recommended for at least five years; if the NGP increases in size by more than 2mm in size, cholecystectomy is indicated. Laparoscopic cholecystectomy is possible but if the surgeon feels that the risk of intra-operative gallbladder perforation is high, conversion to laparotomy should be preferred to avoid potential intra-abdominal tumoral dissemination. When malignant NGP is suspected (size greater than 15mm, signs of locoregional extension on imaging), a comprehensive imaging workup should be performed to search for liver extension: in this setting, radical surgery should be considered.
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Affiliation(s)
- C Valibouze
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France.
| | - M El Amrani
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - S Truant
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - C Leroy
- Department of Radiology and Digestive and Endocrine Imaging, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, 59037 Lille, France
| | - G Millet
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - F R Pruvot
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
| | - P Zerbib
- Digestive and transplantation Department, Lille Nord de France University, Claude Huriez Hospital, University Hospital of Lille, rue Michel-Polonovski, 59037 Lille, France
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Pickering O, Pucher PH, Toale C, Hand F, Anand E, Cassidy S, McEntee G, Toh SKC. Prevalence and Sonographic Detection of Gallbladder Polyps in a Western European Population. J Surg Res 2020; 250:226-231. [PMID: 32106001 DOI: 10.1016/j.jss.2020.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/31/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gallbladder cancer is rare but associated with significant morbidity and mortality necessitating the early identification of premalignant and malignant lesions to improve overall prognosis. Despite limited evidence regarding the effectiveness of transabdominal ultrasound (US) in the detection of gallbladder polyps, it plays a key role in current European guidelines. The aim of this study was to investigate gallbladder polyp prevalence in a western European population and assess the diagnostic accuracy of transabdominal US. METHODS Data from patients who underwent cholecystectomy for US detected gallbladder polypoid lesions at four hospitals in Ireland and the United Kingdom between 2010 and 2018 were retrospectively collected. Patient demographics, ultrasonographic, and histopathologic findings were analyzed. RESULTS A total of 134 patients underwent cholecystectomy for US-detected gallbladder polyps. After histopathologic examination, pseudopolyps were found in 75 (56%) specimens with dysplastic or malignant polyps seen in only six (4.5%) specimens. Mean size for neoplastic polyps was 33 mm. The positive predictive value for US in detecting neoplastic polyps in this study was 4.5%, which is significantly lower than the 10%-15% reported previously. CONCLUSIONS Although the prevalence of neoplastic polyps in this study is higher than in the previous literature, the distribution of pseudopolyps and true polyps is as expected. With all malignant polyps being >10 mm in diameter, these findings support the current size thresholds stated in European guidelines. The poor diagnostic accuracy of US demonstrated may have led to significant number of patients undergoing unnecessary surgical intervention, further supporting the argument for improved strategies for the investigation of gallbladder polyps.
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Affiliation(s)
- Oliver Pickering
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom.
| | - Philip H Pucher
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom
| | - Conor Toale
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fiona Hand
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Easan Anand
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom
| | - Sheena Cassidy
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gerry McEntee
- Department of General Surgery, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Simon K C Toh
- Department of General Surgery, Queen Alexandra Hospital, Portsmouth, Hampshire, United Kingdom
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Kopf H, Schima W, Meng S. [Differential diagnosis of gallbladder abnormalities : Ultrasound, computed tomography, and magnetic resonance imaging]. Radiologe 2019; 59:328-337. [PMID: 30789997 DOI: 10.1007/s00117-019-0504-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CLINICAL ISSUE Due to the high prevalence of clinically suspected cholecystitis or cholecystolithiasis the gallbladder is one of the organs examined the most by imaging. STANDARD RADIOLOGICAL METHODS In most clinical settings ultrasound is the primary imaging method because of its wide availability, speed and superior spatial resolution. In cases of ambiguous findings or potential complications computed tomography (CT) and magnetic resonance imaging (MRI) are used. METHODICAL INNOVATIONS When specific problems arise these imaging modalities may be enhanced by special techniques, e. g. contrast-enhanced ultrasound or dual-energy CT, and specific MRI sequences. PERFORMANCE Special variants of cholecystitis, such as xanthogranulomatous cholecystitis and adenomyomatosis, may pose a particularly difficult diagnostic problem as they may resemble other diseases. Sequelae of cholecystolithiasis, such as the Mirizzi syndrome and acute bowel obstruction, may complicate the imaging algorithm as the location and the symptoms shift. Cases of neoplastic diseases of gallbladder cancer and other malignancies require a broad spectrum of imaging modalities. ACHIEVEMENTS Although the gallbladder can easily be examined with ultrasound, some cases require a more thorough ultrasound examination. In some cases only a combination of multiple imaging modalities yield the diagnosis. Further developments regarding technical issues and the diagnostic algorithm can be expected. PRACTICAL RECOMMENDATIONS Ultrasound is the best first imaging modality. In cases of ambiguous findings or clinical complications CT or MRI are recommended.
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Affiliation(s)
- H Kopf
- Abteilung für Diagnostische und Interventionelle Radiologie, Göttlicher Heiland Krankenhaus, Vinzenzgruppe, Wien, Österreich
| | - W Schima
- Abteilung für Diagnostische und Interventionelle Radiologie, Göttlicher Heiland Krankenhaus, Vinzenzgruppe, Wien, Österreich
| | - S Meng
- Radiologie, KFJ Spital, Wien, Österreich.
- Zentrum für Anatomie und Zellbiologie, Medizinische Universität Wien, Währinger Str. 13, 1090, Wien, Österreich.
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Sun Y, Yang Z, Lan X, Tan H. Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps. Hepatobiliary Surg Nutr 2019; 8:219-227. [PMID: 31245402 DOI: 10.21037/hbsn.2018.12.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Preoperative differentiation of malignant and premalignant gallbladder polyps (GBPs) from benign lesions is a key imperative to guide treatment decision-making. We aimed to characterize the various types of GBPs and sought to identify the risk factors for neoplastic polyps. Our findings may help optimize treatment strategy. Methods Retrospective analysis of 686 patients with post-cholecystectomy pathologically-proven GBPs between January 2003 and December 2016. The patients were classified into non-neoplastic polyp group, benign neoplastic polyp group, and adenoma canceration group. Clinical features, ultrasound findings, and results of laboratory investigations and histopathological examination were reviewed and compared between the groups. Results Out of 686 patients, 542 (79.0%) had non-neoplastic polyps, 134 (19.5%) had neoplastic polyps, and 10 (1.5%) had adenoma canceration. The mean age was 46.06±12.12 years; 383 (55.8%) patients were female. The median (25th percentile, 75th percentile) time between diagnosis and surgery in the cholesterol polyp group [24 (3.5, 60) months] was significantly longer than that in adenoma [12 (2, 60) months] and adenoma canceration [5 (0.475, 12) months] groups. The mean diameter was 1.14±0.61 cm (range, 0.5-8.4 cm). Three hundred twelve (45.5%) patients had solitary polyps and intralesional blood flow was observed in 41 (6.0%) patients. On univariate analysis, age >49.5 years, polyp size >1.15 cm, solitary polyp, intralesional blood flow, absence of symptoms, and lack of cholecystitis showed a significant association with adenoma. On multivariate analysis, polyp size (>1.15 cm), intralesional blood flow, and lack of cholecystitis were independent predictors of adenoma. Conclusions Polyp size >1.15 cm, intralesional blood flow, and lack of cholecystitis were predictors of neoplastic polyps. Malignant transformation of adenoma may occur over a relatively short time.
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Affiliation(s)
- Yongliang Sun
- Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhiying Yang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xu Lan
- Department of Comprehensive Internal Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Haidong Tan
- Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Patel K, Dajani K, Vickramarajah S, Huguet E. Five year experience of gallbladder polyp surveillance and cost effective analysis against new European consensus guidelines. HPB (Oxford) 2019; 21:636-642. [PMID: 30416065 DOI: 10.1016/j.hpb.2018.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/26/2018] [Accepted: 10/14/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder polyp (GBP) surveillance seeks to identify early neoplasms, but practice varies amongst surgical units. Recent European consensus guidelines have recommended an evidence-based GBP surveillance strategy. In a tertiary centre Hepato-Pancreato-Biliary unit we examine GBP surveillance, malignant yield, and assess cost-effectiveness of the new European consensus guidelines. METHODS Respective data were collected from all patients with ultrasonography-detected GBPs between January 2008 and January 2013. RESULTS 558 patients had GBPs detected on ultrasonography. Following initial ultrasonography, 304 (54.5%) had further ultrasonography surveillance of which 168 were in a formal GBP surveillance programme. Pre-malignant/malignant pathology yield was 1.97% with an annual detection rate of 12.0 cases per 1000 GBPs surveyed. Cost-effectiveness analysis of European consensus guidelines calculated annual savings of £209 163 per 1000 GBPs surveyed. Compliance with these guidelines would result in an additional 12.5% of patients under surveillance requiring cholecystectomy. CONCLUSION GBP surveillance uptake was suboptimal at 32.8%. The incidence of pre-malignant/malignant lesions in GBPs emphasises the importance of surveillance for early detection and management with a view to avoiding the poor outcomes associated with more advanced gallbladder cancer. Adherence to the new European consensus guidelines would be clinically cost-effective with significant potential savings demonstrated in this study.
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Affiliation(s)
- Krashna Patel
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Khaled Dajani
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Saranya Vickramarajah
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel Huguet
- Hepatopancreatobiliary Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Funamizu N, Nakabayashi Y. Cavernous Hemangioma of the Gallbladder Masquerading as a Carcinoma. Case Rep Gastroenterol 2019; 13:219-224. [PMID: 31123450 PMCID: PMC6515123 DOI: 10.1159/000500079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/02/2019] [Indexed: 12/04/2022] Open
Abstract
Cavernous hemangioma arising from the gallbladder is extremely rare. Here, we report a cavernous hemangioma of the gallbladder masquerading as a carcinoma. A 75-year-old man was referred to our institution for a follow-up study after gastrectomy. Abdominal computed tomography revealed that the gallbladder was filled with a low-density mass with calcification of the wall. The patient underwent extended cholecystectomy. Histologically, the tumor consisted of vascular endothelial cellular elements and hematomas. The postoperative course was uneventful without complications. Presently, only 7 cases of cavernous hemangioma of the gallbladder have been previously reported. This case serves as an important reminder to consider benign tumors including cavernous hemangioma when investigating all possible causes of a gallbladder tumor.
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Affiliation(s)
- Naotake Funamizu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
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50
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McCain RS, Diamond A, Jones C, Coleman HG. Current practices and future prospects for the management of gallbladder polyps: A topical review. World J Gastroenterol 2018; 24:2844-2852. [PMID: 30018479 PMCID: PMC6048427 DOI: 10.3748/wjg.v24.i26.2844] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/23/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023] Open
Abstract
A gallbladder polyp is an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen. Gallbladder polyps have an estimated prevalence in adults of between 0.3%-12.3%. However, only 5% of polyps are considered to be "true" gallbladder polyps, meaning that they are malignant or have malignant potential. The main radiological modality used for diagnosing and surveilling gallbladder polyps is transabdominal ultrasonography. However, evidence shows that other modalities such as endoscopic ultrasound may improve diagnostic accuracy. These are discussed in turn during the course of this review. Current guidelines recommend cholecystectomy for gallbladder polyps sized 10 mm and greater, although this threshold is lowered when other risk factors are identified. The evidence behind this practice is relatively low quality. This review identifies current gaps in the available evidence and highlights the necessity for further research to enable better decision making regarding which patients should undergo cholecystectomy, and/or radiological follow-up.
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Affiliation(s)
- R Stephen McCain
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Belfast BT12 6BJ, United Kingdom
| | - Anna Diamond
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast BT16 1RH, United Kingdom
| | - Claire Jones
- Mater Hospital, Belfast Health and Social Care Trust, Queens University Belfast, Belfast BT12 6BJ, United Kingdom
| | - Helen G Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BJ, United Kingdom
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