Korean J Gastroenterol.  2025 Jan;85(1):52-63. 10.4166/kjg.2024.130.

Predicting Neoplastic Gallbladder Polyps: The Role of Current Surgical Indications and Preoperative Images

• Jo IH
• Paik CN
• Ahn HG
• You DD
• Han JH
• Kim HA

• KMID: 2565015
• DOI: http://doi.org/10.4166/kjg.2024.130

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.

Keyword

Gallbladder neoplasms; Polyps; Cholecystectomy; Diagnostic imaging; Predictive value of tests

Figure

• 

  Fig. 1 Flowchart for the enrollment of the study participants. CT, computed tomography.

• 

  Fig. 2 Receiver operating characteristic curves of surgical indications for predicting neoplastic polyp, (A) polyp size ≥10 mm; (B) increase in polyp size; (C) a symptomatic patient; (D) age ≥50 years; (E) concomitant gallstone; (F) a single lesion; (G) a sessile morphology. Sens, sensitivity, Spec, specificity; PPV, positive predictive value; NPV, negative predictive value, AUC, area under curve.

• 

  Fig. 3 Receiver operating characteristic curves of the gallbladder polyp size for predicting neoplastic polyp, (A) size measured by abdomen CT scan; (B) size measured by abdomen ultrasound. CT, computed tomography; Sens, sensitivity, Spec, specificity; PPV, positive predictive value; NPV, negative predictive value, AUC, area under curve.

Reference

1. Myers RP, Shaffer EA, Beck PL. 2002; Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol. 16:187–194. DOI: 10.1155/2002/787598. PMID: 11930198.

2. Wiles R, Thoeni RF, Barbu ST, et al. 2017; Management and follow-up of gallbladder polyps: Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery - European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol. 27:3856–3866. DOI: 10.1007/s00330-017-4742-y. PMID: 28185005. PMCID: PMC5544788.

3. Kozuka S, Tsubone N, Yasui A, Hachisuka K. 1982; Relation of adenoma to carcinoma in the gallbladder. Cancer. 50:2226–2234. DOI: 10.1002/1097-0142(19821115)50:10<2226::AID-CNCR2820501043>3.0.CO;2-3. PMID: 7127263.

4. Park JY, Hong SP, Kim YJ, et al. 2009; Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol. 24:219–222. DOI: 10.1111/j.1440-1746.2008.05689.x. PMID: 19054258.

5. Shirah BH, Shirah HA, Zafar SH, Albeladi KB. 2018; Clinical patterns of postcholecystectomy syndrome. Ann Hepatobiliary Pancreat Surg. 22:52–57. DOI: 10.14701/ahbps.2018.22.1.52. PMID: 29536056. PMCID: PMC5845611.

6. Di Ciaula A, Garruti G, Wang DQ, Portincasa P. 2018; Cholecystectomy and risk of metabolic syndrome. Eur J Intern Med. 53:3–11. DOI: 10.1016/j.ejim.2018.04.019. PMID: 29706426. PMCID: PMC8118133.

7. Andrén-Sandberg A. 2012; Diagnosis and management of gallbladder polyps. N Am J Med Sci. 4:203–211. DOI: 10.4103/1947-2714.95897. PMID: 22655278. PMCID: PMC3359430.

8. Latenstein CSS, Alferink LJM, Darwish Murad S, Drenth JPH, van Laarhoven CJHM, de Reuver PR. 2020; The association between cholecystectomy, metabolic syndrome, and nonalcoholic fatty liver disease: A population-based study. Clin Transl Gastroenterol. 11:e00170. DOI: 10.14309/ctg.0000000000000170. PMID: 32352682. PMCID: PMC7263655.

9. Foley KG, Lahaye MJ, Thoeni RF, et al. 2022; Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE. Eur Radiol. 32:3358–3368. DOI: 10.1007/s00330-021-08384-w. PMID: 34918177. PMCID: PMC9038818.

10. Kamaya A, Fung C, Szpakowski JL, et al. 2022; Management of incidentally detected gallbladder polyps: society of radiologists in ultrasound consensus conference recommendations. Radiology. 305:277–289. DOI: 10.1148/radiol.213079. PMID: 35787200.

11. Aziz H, Hewitt DB, Pawlik TM. 2022; Critical analysis of the updated guidelines for management of gallbladder polyps. Ann Surg Oncol. 29:3363–3365. DOI: 10.1245/s10434-022-11701-2. PMID: 35419760.

12. Tsuji S, Sofuni A, Moriyasu F, et al. 2012; Contrast-enhanced ultrasonography in the diagnosis of gallbladder disease. Hepatogastroenterology. 59:336–340. DOI: 10.5754/hge11447. PMID: 21940376.

13. Chantarojanasiri T, Kongkam P. 2017; Endoscopic ultrasound elastography for solid pancreatic lesions. World J Gastrointest Endosc. 9:506–513. DOI: 10.4253/wjge.v9.i10.506. PMID: 29085561. PMCID: PMC5648993.

14. Kim T, Choi YH, Choi JH, Lee SH, Lee S, Lee IS. 2021; Gallbladder polyp classification in ultrasound images using an ensemble convolutional neural network model. J Clin Med. 10:3585. DOI: 10.3390/jcm10163585. PMID: 34441881. PMCID: PMC8396835.

15. Fei X, Lu WP, Luo YK, et al. 2015; Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case-control study. Abdom Imaging. 40:2355–2363. DOI: 10.1007/s00261-015-0485-x. PMID: 26082060.

16. Saverymuttu SH, Grammatopoulos A, Meanock CI, Maxwell JD, Joseph AE. 1990; Gallbladder wall thickening (congestive cholecystopathy) in chronic liver disease: a sign of portal hypertension. Br J Radiol. 63:922–925. DOI: 10.1259/0007-1285-63-756-922. PMID: 2268760.

17. Alotaibi AM. 2023; Gallbladder wall thickness adversely impacts the surgical outcome. Ann Hepatobiliary Pancreat Surg. 27:63–69. DOI: 10.14701/ahbps.22-067. PMID: 36536504. PMCID: PMC9947375.

18. McCain RS, Diamond A, Jones C, Coleman HG. 2018; Current practices and future prospects for the management of gallbladder polyps: A topical review. World J Gastroenterol. 24:2844–2852. DOI: 10.3748/wjg.v24.i26.2844. PMID: 30018479. PMCID: PMC6048427.

19. Kim KH. 2021; Gallbladder polyps: evolving approach to the diagnosis and management. Yeungnam Univ J Med. 38:1–9. DOI: 10.12701/yujm.2020.00213. PMID: 33045805. PMCID: PMC7787897.

20. Roa I, de Aretxabala X, Araya JC, Roa J. 2006; Preneoplastic lesions in gallbladder cancer. J Surg Oncol. 93:615–623. DOI: 10.1002/jso.20527. PMID: 16724345.

21. Wennmacker SZ, van Dijk AH, Raessens JHJ, et al. 2019; Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps. Surg Endosc. 33:1564–1571. DOI: 10.1007/s00464-018-6444-1. PMID: 30203209. PMCID: PMC6484812.

22. Güneş Y, Taşdelen İ, Ergin A, et al. 2022; A new risk scoring system to predict malignancy in gallbladder polyps: A single-center study. J Gastrointest Surg. 26:1846–1852. DOI: 10.1007/s11605-022-05351-8. PMID: 35581462.

23. Kwon W, Jang JY, Lee SE, Hwang DW, Kim SW. 2009; Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci. 24:481–487. DOI: 10.3346/jkms.2009.24.3.481. PMID: 19543513. PMCID: PMC2698196.

24. Ali TA, Abougazia AS, Alnuaimi AS, Mohammed MAM. 2021; 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. 2021:48. DOI: 10.5339/qmj.2021.48. PMID: 34660216. PMCID: PMC8501236.

25. Lee ES. 2014; Recent updates on the diagnosis and management of gallbladder polyps. Korean J Pancreas Biliary Tract. 19:64–70. DOI: 10.15279/kpba.2014.19.2.64.

26. Jang JY, Kim SW, Lee SE, et al. 2009; Differential diagnostic and staging accuracies of high resolution ultrasonography, endoscopic ultrasonography, and multidetector computed tomography for gallbladder polypoid lesions and gallbladder cancer. Ann Surg. 250:943–949. DOI: 10.1097/SLA.0b013e3181b5d5fc. PMID: 19855259.

27. Sadamoto Y, Oda S, Tanaka M, et al. 2002; A useful approach to the differential diagnosis of small polypoid lesions of the gallbladder, utilizing an endoscopic ultrasound scoring system. Endoscopy. 34:959–965. DOI: 10.1055/s-2002-35859. PMID: 12471539.

28. Konstantinidis IT, Deshpande V, Genevay M, et al. 2009; Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience. Arch Surg. 144:441–447. discussion 447DOI: 10.1001/archsurg.2009.46. PMID: 19451486.

29. Rahman R, Simoes EJ, Schmaltz C, Jackson CS, Ibdah JA. 2017; Trend analysis and survival of primary gallbladder cancer in the United States: a 1973-2009 population-based study. Cancer Med. 6:874–880. DOI: 10.1002/cam4.1044. PMID: 28317286. PMCID: PMC5387125.

30. Wang RT, Zhang LQ, Mu YP, et al. 2015; Prognostic significance of preoperative platelet count in patients with gallbladder cancer. World J Gastroenterol. 21:5303–5310. DOI: 10.3748/wjg.v21.i17.5303. PMID: 25954104. PMCID: PMC4419071.