Abstract
Background
Polypoid lesions of the gallbladder (PLG) are common, and most are benign. Few lesions are found to be malignant, but are not preoperatively distinguished as such using common imaging modalities. Therefore, we compared characteristics of benign and malignant PLGs in depth.
Methods
We enrolled 1204 consecutive patients diagnosed with PLG at Taipei Veterans General Hospital between January 2004 and December 2013. Patients underwent either surgery or regular follow-up with various imaging modalities for at least 24 months. The mean follow-up duration was 72 ± 32 months.
Results
Of 1204 patients, 194 underwent surgical treatment and 1010, regular follow-up. In addition, 73 % patients were asymptomatic. The mean PLG size was 6.9 ± 7.7 (range 0.8–129) mm; the PLGs of 337 patients (28 %) grew during their follow-up periods. The majority of PLGs (90.4 %) were single lesions, and 10.5 % of patients had associated gallstones. The PLGs of 20.1 % of surgical patients were malignant. Malignant PLGs were found in 32.4 % of patients ≥50 years old and in 4.7 % of those <50 years old (p < 0.001). Right quadrant abdominal pain, epigastric pain, and body weight loss were the three most common symptoms associated with malignancy. Malignant PLGs were significantly larger than benign lesions (means: 27.5 ± 18.4 mm vs. 12.3 ± 12.3 mm, respectively, p < 0.001). Notably, the size of 5 % of malignant PLGs was 3–5 mm, and that of 8 % was 5–10 mm. The negative predictive value for gallbladder malignancy was 92.8 % based on a size ≥10 mm and 100 % based on a size ≥3 mm.
Conclusions
Our study reassesses the PLG size that warrants more aggressive intervention. Cholecystectomy remains mandatory for PLGs > 10 mm, but should also be considered a definitive diagnostic and treatment modality for PLGs with diameters of 3–10 mm.
Similar content being viewed by others
References
Myers RP, Shaffer EA, Beck PL (2002) Gallbladder polyps: epidemiology, natural history and management. Can J Gastroenterol (Journal Canadien de Gastroenterologie) 16:187–194
Segawa K, Arisawa T, Niwa Y, Suzuki T, Tsukamoto Y, Goto H, Hamajima E, Shimodaira M, Ohmiya N (1992) Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study. Am J Gastroenterol 87:630–633
Jorgensen T, Jensen KH (1990) Polyps in the gallbladder. A prevalence study. Scand J Gastroenterol 25:281–286
Kratzer W, Schmid A, Akinli AS, Thiel R, Mason RA, Schuler A, Haenle MM (2011) [Gallbladder polyps: prevalence and risk factors]. Ultraschall Med (Stuttgart, Germany: 1980) 32(Suppl 1):68–73
Chen CY, Lu CL, Chang FY, Lee SD (1997) Risk factors for gallbladder polyps in the Chinese population. Am J Gastroenterol 92:2066–2068
Christensen AH, Ishak KG (1970) Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 90:423–432
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
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
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 127:622–627
Marangoni G, Hakeem A, Toogood GJ, Lodge JP, Prasad KR (2012) Treatment and surveillance of polypoid lesions of the gallbladder in the United Kingdom. HPB (Oxford) 14:435–440
Yeh CN, Jan YY, Chao TC, Chen MF (2001) Laparoscopic cholecystectomy for polypoid lesions of the gallbladder: a clinicopathologic study. Surg Laparosc Endosc Percutan Tech 11:176–181
Koga A, Watanabe K, Fukuyama T, Takiguchi S, Nakayama F (1988) Diagnosis and operative indications for polypoid lesions of the gallbladder. Arch Surg 123:26–29
Ito H, Hann LE, D’Angelica M, Allen P, Fong Y, Dematteo RP, Klimstra DS, Blumgart LH, Jarnagin WR (2009) Polypoid lesions of the gallbladder: diagnosis and followup. J Am Coll Surg 208:570–575
Park JK, Yoon YB, Kim YT, Ryu JK, Yoon WJ, Lee SH, Yu SJ, Kang HY, Lee JY, Park MJ (2008) Management strategies for gallbladder polyps: Is it possible to predict malignant gallbladder polyps? Gut Liver 2:88–94
Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY (2009) Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 33:2657–2663
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 34:135–139
Irie H, Kamochi N, Nojiri J, Egashira Y, Sasaguri K, Kudo S (2011) High b-value diffusion-weighted MRI in differentiation between benign and malignant polypoid gallbladder lesions. Acta Radiol (Stockholm, Sweden: 1987) 52:236–240
Jang JY, Kim SW, Lee SE, Hwang DW, Kim EJ, Lee JY, Kim SJ, Ryu JK, Kim YT (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
Boulton RA, Adams DH (1997) Gallbladder polyps: when to wait and when to act. Lancet (London, England) 349:817
Yang HL, Sun YG, Wang Z (1992) Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 79:227–229
Mainprize KS, Gould SW, Gilbert JM (2000) Surgical management of polypoid lesions of the gallbladder. Br J Surg 87:414–417
Aldouri AQ, Malik HZ, Waytt J, Khan S, Ranganathan K, Kummaraganti S, Hamilton W, Dexter S, Menon K, Lodge JP, Prasad KR, Toogood GJ (2009) The risk of gallbladder cancer from polyps in a large multiethnic series. Eur J Surg Oncol 35:48–51
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 13:19–25
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
Cairns V, Neal CP, Dennison AR, Garcea G (2012) Risk and cost-effectiveness of surveillance followed by cholecystectomy for gallbladder polyps. Arch Surg 147:1078–1083
Cha BH, Hwang JH, Lee SH, Kim JE, Cho JY, Kim H, Kim SY (2011) Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 17:2216–2222
Andren-Sandberg A (2012) Diagnosis and management of gallbladder polyps. N Am J Med Sci 4:203–211
Kozuka S, Tsubone N, Yasui A, Hachisuka K (1982) Relation of adenoma to carcinoma in the gallbladder. Cancer 50:2226–2234
Park JY, Hong SP, Kim YJ, Kim HJ, Kim HM, Cho JH, Park SW, Song SY, Chung JB, Bang S (2009) Long-term follow up of gallbladder polyps. J Gastroenterol Hepatol 24:219–222
Choi SY, Kim TS, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI (2010) Is it necessary to perform prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones? J Gastroenterol Hepatol 25:1099–1104
Song HL, Shin JH, Kim H, Park YL, Yoo CH, Son BH, Yoon JS, Kim HO (2012) Clinical and radiologic preoperative predicting factors for GB cholesterol polyp. J Korean Surg Soc 82:232–237
Csendes A, Burgos AM, Csendes P, Smok G, Rojas J (2001) Late follow-up of polypoid lesions of the gallbladder smaller than 10 mm. Ann Surg 234:657–660
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
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Shu-Cheng Chou, Shih-Chin Chen, Yi-Ming Shyr, and Shin-E Wang have no conflicts of interest or financial ties to disclose.
Additional information
Shu-Cheng Chou and Yi-Ming Shyr contributed equally to this paper.
Rights and permissions
About this article
Cite this article
Chou, SC., Chen, SC., Shyr, YM. et al. Polypoid lesions of the gallbladder: analysis of 1204 patients with long-term follow-up. Surg Endosc 31, 2776–2782 (2017). https://doi.org/10.1007/s00464-016-5286-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-5286-y