Advertisement

Abdominal Imaging

, Volume 39, Issue 2, pp 334–341 | Cite as

CT differentiation of 1–2-cm gallbladder polyps: benign vs malignant

  • E Rang Song
  • Woo-Suk ChungEmail author
  • Hye Young Jang
  • Minjae Yoon
  • Eun Jung Cha
Article

Abstract

Purpose

To evaluate MDCT findings of 1–2-cm sized gallbladder (GB) polyps for differentiation between benign and malignant polyps.

Methods

Institutional review board approval was obtained, and informed consent was waived. Portal venous phase CT scans of 1–2-cm sized GB polyps caused by various pathologic conditions were retrospectively reviewed by two blinded observers. Among the 36 patients identified, 21 had benign polyps with the remaining 15 having malignant polyps. Size, margin, and shape of GB polyps were evaluated. Attenuation values of the polyps, including mean attenuation, maximum attenuation, and standard deviation, were recorded. As determined by visual inspection, the degree of polyp enhancement was evaluated. Using these CT findings, each of the two radiologists assessed and recorded individual diagnostic confidence for differentiating benign versus malignant polyps on a 5-point scale. The diagnostic performance of CT was evaluated using a receiver operating characteristic curve analysis.

Results

There was no significant difference in size between benign and malignant GB polyps. Ill-defined margin and sessile morphology were significantly associated with malignant polyp. There was a significant difference in mean and maximum attenuation values between benign and malignant GB polyps. Mean standard deviation value of malignant polyps was significantly higher than that of benign polyps. All malignant polyps showed either hyperenhancement or marked hyperenhancement. A z value for the diagnosis of malignant GB polyps was 0.905.

Conclusion

Margin, shape, and enhancement degree are helpful in differentiating between benign and malignant polyps of 1–2-cm sizes.

Keywords

Biliary tree Gallbladder Polyp Neoplasm MDCT 

References

  1. 1.
    Christensen AH, Ishak KG (1970) Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 90:423–432PubMedGoogle Scholar
  2. 2.
    Piehler JM, Crichlow RW (1978) Primary carcinoma of the gallbladder. Surg Gynecol Obstet 147:929–942PubMedGoogle Scholar
  3. 3.
    Chen CY, Lu CL, Chang FY, Lee SD (1997) Risk factors for gallbladder polyps in the Chinese population. Am J Gastroenterol 92:2066–2068PubMedGoogle Scholar
  4. 4.
    Rustagi T, Dasanu CA (2012) Risk factors for gallbladder cancer and cholangiocarcinoma: similarities, differences and updates. J Gastrointest Cancer 43:137–147PubMedCrossRefGoogle Scholar
  5. 5.
    Terzi C, Sokmen S, Seckin S, Albayrak L, Ugurlu M (2000) Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 127:622–627PubMedCrossRefGoogle Scholar
  6. 6.
    Cheon YK, Cho WY, Lee TH, et al. (2009) Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps. World J Gastroenterol 15:2361–2366PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    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 69:1244–1250PubMedCrossRefGoogle Scholar
  8. 8.
    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 52:372–379PubMedCrossRefGoogle Scholar
  9. 9.
    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 250:943–949PubMedCrossRefGoogle Scholar
  10. 10.
    Koh T, Taniguchi H, Yamaguchi A, Kunishima S, Yamagishi H (2003) Differential diagnosis of gallbladder cancer using positron emission tomography with fluorine-18-labeled fluoro-deoxyglucose (FDG-PET). J Surg Oncol 84:74–81PubMedCrossRefGoogle Scholar
  11. 11.
    Lee J, Yun M, Kim KS, Lee JD, Kim CK (2012) Risk stratification of gallbladder polyps (1–2 cm) for surgical intervention with 18F-FDG PET/CT. J Nucl Med 53:353–358PubMedCrossRefGoogle Scholar
  12. 12.
    Nishiyama Y, Yamamoto Y, Fukunaga K, et al. (2006) Dual-time-point 18F-FDG PET for the evaluation of gallbladder carcinoma. J Nucl Med 47:633–638PubMedGoogle Scholar
  13. 13.
    Park KW, Kim SH, Choi SH, Lee WJ (2010) Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multi-detector row computed tomography. J Comput Assist Tomogr 34:135–139PubMedCrossRefGoogle Scholar
  14. 14.
    Rodriguez-Fernandez A, Gomez-Rio M, Llamas-Elvira JM, et al. (2004) Positron-emission tomography with fluorine-18-fluoro-2-deoxy-d-glucose for gallbladder cancer diagnosis. Am J Surg 188:171–175PubMedCrossRefGoogle Scholar
  15. 15.
    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 34:959–965PubMedCrossRefGoogle Scholar
  16. 16.
    Zielinski MD, Atwell TD, Davis PW, Kendrick ML, Que FG (2009) Comparison of surgically resected polypoid lesions of the gallbladder to their pre-operative ultrasound characteristics. J Gastrointest Surg 13:19–25PubMedCrossRefGoogle Scholar
  17. 17.
    Kyokane T, Akita Y, Katayama M, et al. (1994) A case of inflammatory polyp of the gallbladder which was difficult to differentiate from cancer. Nihon Shokakibyo Gakkai Zasshi 91:1062–1066PubMedGoogle Scholar
  18. 18.
    Maeyama R, Yamaguchi K, Noshiro H, et al. (1998) A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma. J Gastroenterol 33:770–774PubMedCrossRefGoogle Scholar
  19. 19.
    Ishikawa O, Ohhigashi H, Imaoka S, et al. (1989) The difference in malignancy between pedunculated and sessile polypoid lesions of the gallbladder. Am J Gastroenterol 84:1386–1390PubMedGoogle Scholar
  20. 20.
    Sheth S, Bedford A, Chopra S (2000) Primary gallbladder cancer: recognition of risk factors and the role of prophylactic cholecystectomy. Am J Gastroenterol 95:1402–1410PubMedCrossRefGoogle Scholar
  21. 21.
    Furukawa H, Takayasu K, Mukai K, et al. (1995) CT evaluation of small polypoid lesions of the gallbladder. Hepatogastroenterology 42:800–810PubMedGoogle Scholar
  22. 22.
    Kim JY, Lee JM, Han JK, et al. (2007) Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures. J Magn Reson Imaging 26:304–312PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • E Rang Song
    • 1
  • Woo-Suk Chung
    • 1
    Email author
  • Hye Young Jang
    • 1
  • Minjae Yoon
    • 1
  • Eun Jung Cha
    • 2
  1. 1.Department of Diagnostic RadiologyKonyang University Hospital, Konyang University College of MedicineDaejeonRepublic of Korea
  2. 2.Department of PathologyKonyang University Hospital, Konyang University College of MedicineDaejeonRepublic of Korea

Personalised recommendations