Endoscopic ultrasonography does not differentiate neoplastic from non-neoplastic small gallbladder polyps.

Institute for Digestive Research and Digestive Disease Center, Soon Chun Hyang University College of Medicine, 657 Hannam-Dong, Yongsan-Ku, Seoul, South Korea.
World Journal of Gastroenterology (Impact Factor: 2.37). 06/2009; 15(19):2361-6.
Source: PubMed


To assess the ability of endoscopic ultrasonography (EUS) to differentiate neoplastic from non-neoplastic polypoid lesions of the gallbladder (PLGs).
The uses of EUS and transabdominal ultrasonography (US) were retrospectively analyzed in 94 surgical cases of gallbladder polyps less than 20 mm in diameter.
The prevalence of neoplastic lesions with a diameter of 5-10 mm was 17.2% (10/58); 11-15 mm, 15.4% (4/26), and 16-20 mm, 50% (5/10). The overall diagnostic accuracies of EUS and US for small PLGs were 80.9% and 63.9% (P < 0.05), respectively. EUS correctly distinguished 12 (63.2%) of 19 neoplastic PLGs but was less accurate for polyps less than 1.0 cm (4/10, 40%) than for polyps greater than 1.0 cm (8/9, 88.9%) (P = 0.02).
Although EUS was more accurate than US, its accuracy for differentiating neoplastic from non-neoplastic PLGs less than 1.0 cm was low. Thus, EUS alone is not sufficient for determining a treatment strategy for PLGs of less than 1.0 cm.

    • "EUS is considered to be superior to conventional US for imaging gallbladder lesions, because EUS can provide high-resolution images of small lesions with higher ultrasound frequencies (7.5–12 MHz vs. 3.5–5 MHz).[8] Although EUS was more accurate than US, its accuracy for differentiating malignancy less than 1.0 cm was low.[2324] "
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    ABSTRACT: Gallbladder polyps are relatively common in adults and affect approximately 5% of the population. Polypoid lesions of the gallbladder are asymptomatic and are detected during abdominal ultrasonography performed for unrelated conditions. Although the majority of gallbladder polyps are benign, malignant transformation is a concern. The differentiation of benign from malignant lesions can be challenging. Several features, including polyp size, number, rapid growth, sessile lesion, patient age and gallbladder wall thickening are important discriminating features between benign and malignant polyps and may increase the risk of gallbladder cancer. Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy. Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are unable to differentiate between benign and malignant polyp of the gallbladder with any certainty. We recommend surgical treatment of polypoid lesions of the gallbladder in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, sessile, greater than 6 mm in diameter, that demonstrate rapid growth, vascularity and invasion or are associated with gallstones. KeywordsGallbladder polyps-Polypoid lesions of the gallbladder-Benign gallbladder polyps-Malignant gallbladder polyps-Gallbladder cancer
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