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The efficacy of real-time colour Doppler flow imaging on endoscopic ultrasonography for differential diagnosis between neoplastic and non-neoplastic gallbladder polyps

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We evaluated the usefulness of real-time colour Doppler flow (CDF) endoscopic ultrasonography (EUS) for differentiating neoplastic gallbladder (GB) polyps from non-neoplastic polyps.

Methods

Between August 2014 and December 2016, a total of 233 patients with GB polyps who underwent real-time CDF-EUS were consecutively enrolled in this prospective study. CDF imaging was subjectively categorized for each patient as: strong CDF pattern, weak CDF pattern and no CDF pattern.

Results

Of the 233 patients, 115 underwent surgical resection. Of these, there were 90 cases of non-neoplastic GB polyps and 23 cases of neoplastic GB polyps. In a multivariate analysis, a strong CDF pattern was the most significant predictive factor for neoplastic polyps; sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 52.2 %, 79.4 %, 38.7 %, 86.9 % and 73.9 %, respectively. Solitary polyp and polyp size were associated with an increased risk of neoplasm.

Conclusions

The presence of a strong CDF pattern as well as solitary and larger polyps on EUS may be predictive of neoplastic GB polyps. As real-time CDF-EUS poses no danger to the patient and requires no additional equipment, it is likely to become a supplemental tool for the differential diagnosis of GB polyps.

Key points

• Differential diagnosis between neoplastic polyps and non-neoplastic polyps of GB is limited.

• The use of real-time CDF-EUS was convenient, with high agreement between operators.

• The real-time CDF-EUS is helpful in differential diagnosis of GB polyps.

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Abbreviations

CDF:

Colour Doppler flow

CEH-EUS:

Contrast-enhanced harmonic EUS

CI:

Confidence interval

EUS:

Endoscopic ultrasonography

GB:

Gallbladder

NPV:

Negative predictive value

OR:

Odds ratio

PPV:

Positive predictive value

SD:

Standard deviation

References

  1. Segawa K, Arisawa T, Niwa Y et al (1992) Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study. Am J Gastroenterol 87:630–633

    CAS  PubMed  Google Scholar 

  2. Chen CY, Lu CL, Chang FY, Lee SD (1997) Risk factors for gallbladder polyps in the Chinese population. Am J Gastroenterol 92:2066–2068

    CAS  PubMed  Google Scholar 

  3. Jorgensen T, Jensen KH (1990) Polyps in the gallbladder. A prevalence study. Scand J Gastroenterol 25:281–286

    CAS  PubMed  Google Scholar 

  4. Laitio M (1983) Histogenesis of epithelial neoplasms of human gallbladder II. Classification of carcinoma on the basis of morphological features. Pathol Res Pract 178:57–66

    Article  CAS  PubMed  Google Scholar 

  5. Sarkut P, Kilicturgay S, Ozer A, Ozturk E, Yilmazlar T (2013) Gallbladder polyps: factors affecting surgical decision. World J Gastroenterol 19:4526–4530

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zemour J, Marty M, Lapuyade B, Collet D, Chiche L (2014) Gallbladder tumor and pseudotumor: Diagnosis and management. J Visc Surg 151:289–300

    Article  CAS  PubMed  Google Scholar 

  7. Furukawa H, Kosuge T, Shimada K et al (1998) Small polypoid lesions of the gallbladder: differential diagnosis and surgical indications by helical computed tomography. Arch Surg 133:735–739

    CAS  PubMed  Google Scholar 

  8. Sugiyama M, Xie XY, Atomi Y, Saito M (1999) Differential diagnosis of small polypoid lesions of the gallbladder: the value of endoscopic ultrasonography. Ann Surg 229:498–504

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 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

    Article  CAS  PubMed  Google Scholar 

  10. Sugiyama M, Atomi Y, Kuroda A, Muto T, Wada N (1995) Large cholesterol polyps of the gallbladder: diagnosis by means of US and endoscopic US. Radiology 196:493–497

    Article  CAS  PubMed  Google Scholar 

  11. Choi WB, Lee SK, Kim MH et al (2000) A new strategy to predict the neoplastic polyps of the gallbladder based on a scoring system using EUS. Gastrointest Endosc 52:372–379

    Article  CAS  PubMed  Google Scholar 

  12. Sugiyama M, Atomi Y, Yamato T (2000) Endoscopic ultrasonography for differential diagnosis of polypoid gall bladder lesions: analysis in surgical and follow up series. Gut 46:250–254

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Andren-Sandberg A (2012) Diagnosis and management of gallbladder polyps. N Am J Med Sci 4:203–211

    Article  PubMed  PubMed Central  Google Scholar 

  14. Inui K, Yoshino J, Miyoshi H (2011) Diagnosis of gallbladder tumors. Intern Med 50:1133–1136

    Article  PubMed  Google Scholar 

  15. Cho JH, Park JY, Kim YJ et al (2009) Hypoechoic foci on EUS are simple and strong predictive factors for neoplastic gallbladder polyps. Gastrointest Endosc 69:1244–1250

    Article  PubMed  Google Scholar 

  16. Hirooka Y, Naitoh Y, Goto H, Furukawa T, Ito A, Hayakawa T (1996) Differential diagnosis of gall-bladder masses using colour Doppler ultrasonography. J Gastroenterol Hepatol 11:840–846

    Article  CAS  PubMed  Google Scholar 

  17. Li D, Dong BW, Wu YL, Yan K (1994) Image-directed and color Doppler studies of gallbladder tumors. J Clin Ultrasound 22:551–555

    Article  CAS  PubMed  Google Scholar 

  18. Ueno N, Tomiyama T, Tano S, Wada S, Kimura K (1996) Diagnosis of gallbladder carcinoma with color Doppler ultrasonography. Am J Gastroenterol 91:1647–1649

    CAS  PubMed  Google Scholar 

  19. Berk RN, van der Vegt JH, Lichtenstein JE (1983) The hyperplastic cholecystoses: cholesterolosis and adenomyomatosis. Radiology 146:593–601

    Article  CAS  PubMed  Google Scholar 

  20. Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363

    PubMed  Google Scholar 

  21. Choi JH, Seo DW, Choi JH et al (2013) Utility of contrast-enhanced harmonic EUS in the diagnosis of malignant gallbladder polyps (with videos). Gastrointest Endosc 78:484–493

    Article  PubMed  Google Scholar 

  22. Mizuguchi M, Kudo S, Fukahori T et al (1997) Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer. Eur Radiol 7:1323–1327

    Article  CAS  PubMed  Google Scholar 

  23. Kim JH, Lee JY, Baek JH et al (2015) High-resolution sonography for distinguishing neoplastic gallbladder polyps and staging gallbladder cancer. AJR Am J Roentgenol 204:W150–W159

    Article  PubMed  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. Numata K, Oka H, Morimoto M et al (2007) Differential diagnosis of gallbladder diseases with contrast-enhanced harmonic gray scale ultrasonography. J Ultrasound Med 26:763–774

    Article  PubMed  Google Scholar 

  26. Yang HL, Sun YG, Wang Z (1992) Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 79:227–229

    Article  CAS  PubMed  Google Scholar 

  27. Bang S (2009) Natural course and treatment strategy of gallbladder polyp. Korean J Gastroenterol 53:336–340

    Article  PubMed  Google Scholar 

  28. Park CH, Chung MJ, Oh TG et al (2013) Differential diagnosis between gallbladder adenomas and cholesterol polyps on contrast-enhanced harmonic endoscopic ultrasonography. Surg Endosc 27:1414–1421

    Article  PubMed  Google Scholar 

  29. Azuma T, Yoshikawa T, Araida T, Takasaki K (2001) Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography. Am J Surg 181:65–70

    Article  CAS  PubMed  Google Scholar 

  30. Cheon YK, Cho WY, Lee TH et al (2009) Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps. World J Gastroenterol 15:2361–2366

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lee JS, Kim JH, Kim YJ et al (2017) Diagnostic accuracy of transabdominal high-resolution US for staging gallbladder cancer and differential diagnosis of neoplastic polyps compared with EUS. Eur Radiol 27:3097–3103

    Article  PubMed  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. Myers RP, Shaffer EA, Beck PL (2002) Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol 16:187–194

    Article  PubMed  Google Scholar 

  34. Corwin MT, Siewert B, Sheiman RG, Kane RA (2011) Incidentally detected gallbladder polyps: is follow-up necessary?--Long-term clinical and US analysis of 346 patients. Radiology 258:277–282

    Article  PubMed  Google Scholar 

  35. Terzi C, Sokmen S, Seckin S, Albayrak L, Uğurlu M (2000) Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 127:622–627

    Article  CAS  PubMed  Google Scholar 

  36. Kubota K, Bandai Y, Noie T, Ishizaki Y, Teruya M, Makuuchi M (1995) How should polypoid lesions of the gallbladder be treated in the era of laparoscopic cholecystectomy? Surgery. 117:481–487

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea

    Su Young Kim, Jae Hee Cho, Eui Joo Kim & Yeon Suk Kim

  2. Department of Pathology, Gachon University, Gil Medical Center, Incheon, Republic of Korea

    Dong Hae Chung

  3. Department of Surgery, Gachon University, Gil Medical Center, Incheon, Republic of Korea

    Kun Kuk Kim & Yeon Ho Park

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  1. Su Young Kim
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  7. Yeon Suk Kim
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Corresponding author

Correspondence to Jae Hee Cho.

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Guarantor

The scientific guarantor of this publication is Dong Kyun Park

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Cite this article

Kim, S.Y., Cho, J.H., Kim, E.J. et al. The efficacy of real-time colour Doppler flow imaging on endoscopic ultrasonography for differential diagnosis between neoplastic and non-neoplastic gallbladder polyps. Eur Radiol 28, 1994–2002 (2018). https://doi.org/10.1007/s00330-017-5175-3

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  • DOI: https://doi.org/10.1007/s00330-017-5175-3

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