Diagnostic accuracy of transabdominal ultrasound for the detection of gallbladder polyps
EAES Academy. Lucocq J. 07/05/22; 363044; P088
Dr. James Lucocq
Contributions
Contributions
Abstract
Introduction
Gallbladder cancer is associated with significant morbidity and mortality. Early identification of pre-malignant or low stage tumours improves prognosis. The evidence supporting transabdominal ultrasound (US) in the detection of gallbladder polyps is limited yet it is the main diagnostic imaging modality. The aim of the present study is to investigate the diagnostic accuracy of transabdominal US for true gallbladder polyps.
Method
A cohort of 2768 patients who underwent a laparoscopic cholecystectomy (LC) were included and the pre-operative radiological findings and histopathology results were reported. The rate of true polyps and the utility of USS for the identification of polyps were determined.
Results:
Fifty-seven patients (2.1%) had polyps identified on ultrasound pre-operatively (median number, 1; median size, 0.5cm). Three-point seven percent (2/57) were true polyps, 28.1% (16/57) pseudo-polyps and in 68.4% of cases (39/57) no polyps were found on histopathological analysis. US demonstrated a sensitivity, specificity, PPV and NPV for polyps of 75%, 98.6%, 31.6% and 99.8%, respectively. The true polyps measured 0.9cm and 1.6cm and were larger than other polyps on ultrasound (p=0.03).
Conclusion:
Despite current guidance, patients frequently undergo cholecystectomy for small polyps (<1cm). In most cases (96.4%) these are not found or were pseudo-polyps on histopathology. USS is a poor modality for the identification of true polyps that may subject the patient to undue anxiety, unnecessary follow-up and cholecystectomy. The utilisation of alternative imaging modalities such as MRI should be investigated further.
Gallbladder cancer is associated with significant morbidity and mortality. Early identification of pre-malignant or low stage tumours improves prognosis. The evidence supporting transabdominal ultrasound (US) in the detection of gallbladder polyps is limited yet it is the main diagnostic imaging modality. The aim of the present study is to investigate the diagnostic accuracy of transabdominal US for true gallbladder polyps.
Method
A cohort of 2768 patients who underwent a laparoscopic cholecystectomy (LC) were included and the pre-operative radiological findings and histopathology results were reported. The rate of true polyps and the utility of USS for the identification of polyps were determined.
Results:
Fifty-seven patients (2.1%) had polyps identified on ultrasound pre-operatively (median number, 1; median size, 0.5cm). Three-point seven percent (2/57) were true polyps, 28.1% (16/57) pseudo-polyps and in 68.4% of cases (39/57) no polyps were found on histopathological analysis. US demonstrated a sensitivity, specificity, PPV and NPV for polyps of 75%, 98.6%, 31.6% and 99.8%, respectively. The true polyps measured 0.9cm and 1.6cm and were larger than other polyps on ultrasound (p=0.03).
Conclusion:
Despite current guidance, patients frequently undergo cholecystectomy for small polyps (<1cm). In most cases (96.4%) these are not found or were pseudo-polyps on histopathology. USS is a poor modality for the identification of true polyps that may subject the patient to undue anxiety, unnecessary follow-up and cholecystectomy. The utilisation of alternative imaging modalities such as MRI should be investigated further.
Introduction
Gallbladder cancer is associated with significant morbidity and mortality. Early identification of pre-malignant or low stage tumours improves prognosis. The evidence supporting transabdominal ultrasound (US) in the detection of gallbladder polyps is limited yet it is the main diagnostic imaging modality. The aim of the present study is to investigate the diagnostic accuracy of transabdominal US for true gallbladder polyps.
Method
A cohort of 2768 patients who underwent a laparoscopic cholecystectomy (LC) were included and the pre-operative radiological findings and histopathology results were reported. The rate of true polyps and the utility of USS for the identification of polyps were determined.
Results:
Fifty-seven patients (2.1%) had polyps identified on ultrasound pre-operatively (median number, 1; median size, 0.5cm). Three-point seven percent (2/57) were true polyps, 28.1% (16/57) pseudo-polyps and in 68.4% of cases (39/57) no polyps were found on histopathological analysis. US demonstrated a sensitivity, specificity, PPV and NPV for polyps of 75%, 98.6%, 31.6% and 99.8%, respectively. The true polyps measured 0.9cm and 1.6cm and were larger than other polyps on ultrasound (p=0.03).
Conclusion:
Despite current guidance, patients frequently undergo cholecystectomy for small polyps (<1cm). In most cases (96.4%) these are not found or were pseudo-polyps on histopathology. USS is a poor modality for the identification of true polyps that may subject the patient to undue anxiety, unnecessary follow-up and cholecystectomy. The utilisation of alternative imaging modalities such as MRI should be investigated further.
Gallbladder cancer is associated with significant morbidity and mortality. Early identification of pre-malignant or low stage tumours improves prognosis. The evidence supporting transabdominal ultrasound (US) in the detection of gallbladder polyps is limited yet it is the main diagnostic imaging modality. The aim of the present study is to investigate the diagnostic accuracy of transabdominal US for true gallbladder polyps.
Method
A cohort of 2768 patients who underwent a laparoscopic cholecystectomy (LC) were included and the pre-operative radiological findings and histopathology results were reported. The rate of true polyps and the utility of USS for the identification of polyps were determined.
Results:
Fifty-seven patients (2.1%) had polyps identified on ultrasound pre-operatively (median number, 1; median size, 0.5cm). Three-point seven percent (2/57) were true polyps, 28.1% (16/57) pseudo-polyps and in 68.4% of cases (39/57) no polyps were found on histopathological analysis. US demonstrated a sensitivity, specificity, PPV and NPV for polyps of 75%, 98.6%, 31.6% and 99.8%, respectively. The true polyps measured 0.9cm and 1.6cm and were larger than other polyps on ultrasound (p=0.03).
Conclusion:
Despite current guidance, patients frequently undergo cholecystectomy for small polyps (<1cm). In most cases (96.4%) these are not found or were pseudo-polyps on histopathology. USS is a poor modality for the identification of true polyps that may subject the patient to undue anxiety, unnecessary follow-up and cholecystectomy. The utilisation of alternative imaging modalities such as MRI should be investigated further.
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