Contrast-Enhanced CT and Ultrasonography Features of Intracholecystic Papillary Neoplasm with or without associated Invasive Carcinoma

Abstract

Objective To assess the contrast-enhanced CT and ultrasonography (US) findings of intracholecystic papillary neoplasm (ICPN) and determine the imaging features predicting ICPN associated with invasive carcinoma (ICPN-IC). Materials and Methods In this retrospective study, we enrolled 119 consecutive patients, including 60 male and 59 female, with a mean age ± standard deviation of 63.3 ± 12.1 years, who had pathologically confirmed ICPN (low-grade dysplasia [DP] = 34, high-grade DP = 35, IC = 50) and underwent preoperative CT or US. Two radiologists independently assessed the CT and US findings, focusing on wall and polypoid lesion characteristics. The likelihood of ICPN-IC was graded on a 5-point scale. Univariable and multivariable logistic regression analyses were performed to identify significant predictors of ICPN-IC separately for wall and polypoid lesion findings. The performances of CT and US in distinguishing ICPN-IC from ICPN with DP (ICPN-DP) was evaluated using the area under the receiver operating characteristic curve (AUC). Results For wall characteristics, the maximum wall thickness (adjusted odds ratio [aOR] = 1.4; 95% confidence interval [CI]: 1.1–1.9) and mucosal discontinuity (aOR = 5.6; 95% CI: 1.3–23.4) on CT were independently associated with ICPN-IC. Among 119 ICPNs, 110 (92.4%) showed polypoid lesions. Regarding polypoid lesion findings, multiplicity (aOR = 4.0; 95% CI: 1.6–10.4), lesion base wall thickening (aOR = 6.0; 95% CI: 2.3–15.8) on CT, and polyp size (aOR = 1.1; 95% CI: 1.0–1.2) on US were independently associated with ICPN-IC. CT showed a higher diagnostic performance than US in predicting ICPN-IC (AUC = 0.793 vs. 0.676; p = 0.002). Conclusion ICPN showed polypoid lesions and/or wall thickening on CT or US. A thick wall, multiplicity, presence of wall thickening in the polypoid lesion base, and large polyp size are imaging findings independently associated with invasive cancer and may be useful for differentiating ICPN-IC from ICPN-DP.

Contemporary diagnosis and management of gallbladder polyps

“…[64] Subsequently, a rising debate addresses the necessity of frequent and long-term US scheduled follow-up for small polyps. [65] The imaging features as shown in Table 3, included size, single or multiple lesions, sessile or pedunculated shape, base dimpling and wall thickening, smooth or lobulated surface, foci in the lesion, hypo-iso-hyper echo level, and homo/heterogeneous echo pattern. Wall thickening with enhancement and a single, large, sessile polyp support malignancy.…”