Incidental Findings of Gallbladder and Bile Ducts—Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening—A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper

Jenssen, Christian; Lorentzen, T.; Dietrich, Christoph F.; Lee, Jae Young; Chaubal, Nitin; Choi, Buyng Ihn; Rosenberg, Jacob; Gutt, Carsten N.; Nolsøe, Christian Pállson

doi:10.1016/j.ultrasmedbio.2022.06.016

Cited by 13 publications

(15 citation statements)

References 209 publications

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“…In the presence of a history of right upper abdominal pain and inflammatory findings, thickening of the gallbladder wall usually is associated with acute cholecystitis. However, in the absence of clinical symptoms of cholecystitis, consideration should be given to various perspectives, especially gallbladder cancer ( 16 ). Gallbladder cancer presents with no obvious symptoms during the early stages, progresses rapidly, and is prone to recurrence and metastasis ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of the gallbladder reporting and data system combined with color doppler flow imaging for gallbladder cancer in the Asian population

Wang,

Lv,

2024

Front. Oncol.

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PurposeEvaluating the performance of the Gallbladder Reporting and Data System (GB-RADS) combined with Color Doppler Flow Imaging (CDFI) for the diagnosis of gallbladder wall thickening disease in an Asian population.MethodsIn this study, the lesions were classified and the actual incidence rate of malignant tumors was calculated for each GB-RADS category, following the guidelines provided by GB-RADS. To evaluate the diagnostic performance of GB-RADS and GB-RADS combined with CDFI, we plotted Receiver Operator Characteristic (ROC) curves. The sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (AC) were also calculated. Inter-observer agreement (IRA) between the two observers was assessed using Kappa values.ResultsThe incidence of malignancy risk for GB-RADS 2, 3, 4, and 5 was 9%, 12.5%, 72.2%, and 100%. The AUC for GB-RADS was 0.855 (95% CI: 0.800-0.900), with a sensitivity of 82.5%, a specificity of 84.6%, and an accuracy of 83.8%. The AUC of GB-RADS combined with CDFI was 0.965 (95% CI: 0.930-0.985), with a sensitivity of 96.2%, a specificity of 94.6%, and an accuracy of 95.2%. The AUC, sensitivity, specificity, and accuracy of GB-RADS combined with CDFI for diagnosing gallbladder malignancy were higher than those of GB-RADS alone, and the differences were statistically significant (all P < 0.05). The IRA was excellent between the two observers (Kappa = 0.870).ConclusionsGB-RADS combined with CDFI demonstrated excellent diagnostic accuracy when it comes to distinguishing various diseases that caused gallbladder wall thickening in the Asian population, which has good clinical value and can improve the detection rate of malignant tumors in patients with gallbladder wall thickening.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of the gallbladder reporting and data system combined with color doppler flow imaging for gallbladder cancer in the Asian population

Wang,

Lv,

2024

Front. Oncol.

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“…There are a number of consensus statements on the management of GBPs. 5,[7][8][9] The aim of this paper was to review and summarise the current literature and these consensus statements in order to provide GPs with an approach to management based on the available guidance.…”

Section: Aimmentioning

confidence: 99%

An approach to managing gallbladder polyps for the general practitioner

Chidambaram,

Wijesuriya,

Pradhan

2024

Aust J Gen Pract

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BackgroundGallbladder polyps are increasingly being identified due to the widespread use of abdominal ultrasound imaging. They are concerning lesions due to their potential malignant risk. It is hoped that managing them correctly will play a role in improving poor survival rates of gallbladder cancer. Awareness of these lesions is lacking. Management continues to be guided by expert opinion and observational studies and a number of consensus statements exist. An approach to managing gallbladder polyps for the general practitionerAn approach to managing gallbladder polyps for the general practitioner Clinical

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“…The most widely used diagnostic tool as a first step in day practice is abdominal US, [25,[46][47][48][49] followed by CT [50][51][52] and MRI, [3,10,20,53,54] to evaluate GB pathology, particularly for differentiating benign from malignant lesions. CT or better MRI can overcome any misdiagnosis of conventional US incidental findings alone that may lead to potentially unnecessary operations.…”

Section: Diagnosismentioning

confidence: 99%

Contemporary diagnosis and management of gallbladder polyps

Pavlidis,

Galanis,

Pavlidis

2023

Gastroenterol Funct Med

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Gallbladder (GB) polyps are present in 5%–10% of the general population and consist of true neoplastic polyps (adenomas) and pseudopolyps (predominantly cholesterol, inflammatory, hyperplastic, focal adenomyomatosis). True polyps, although relatively rare neoplastic lesions (0.5%) are considered an important factor in malignant transformation and cancer development (5%) when their size is ≥ 1 cm. Given that it is essential to diagnose GB adenocarcinoma at an early stage to optimize therapeutic management, controversy exists about whether cholecystectomy is always necessary. Their imaging characteristics, size ≥ 1 cm, age > 50 years and genetic predisposition determine the indications for immediate cholecystectomy. In younger patients with polyps < 1 cm in size and without a familial history of GB carcinoma, imaging follow-up by ultrasound (US) seems to be a reasonable recommended policy. A scoring system by multivariate analysis (cross-sectional area > 123 mm2, positive blood flow signal, age > 55.5 years, alanine aminotransferase (ALT) levels > 50 U/L and an ALT/AST (aspartate aminotransferase) ratio > 0.77) can accurately predict true polyps. The widely accepted size threshold for US follow-up is 7 mm, and for intervention, it is 10 mm. Computed tomography or better magnetic resonance imaging can overcome any misdiagnosis of conventional US incidental findings alone that may lead to potentially unnecessary operations. In challenging cases, high-resolution US, novel three-dimensional US, endoscopic US or contrast-enhanced endoscopic US could be helpful. Novel microflow imaging can safely predict polyps. Risk factors for malignancy include age > 60 years, large gallstones, primary sclerosing cholangitis, Asian ethnicity and sessile polyps accompanied by focal gallbladder wall thickening > 4 mm. For polyps sized 6–9 mm, the absence of growth at recommended follow-up (6 months, one year, and two years) indicates treatment discontinuation; however, it is not required for size < 5 mm without risk factors. In addition to laparoscopic cholecystectomy, the standard management, novel interventional modalities preserving the GB in selected cases include per-oral transmural endoscopic resection of GB polyps after a bridge of endoscopic US-guided cholecystostomy or laparoscopic gallbladder-preserving polypectomy. Generally, there are still no precise and strong evidence-based guidelines; thus, the management policy of GB polyps should be individualized in ambiguous cases.

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Incidental Findings of Gallbladder and Bile Ducts—Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening—A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper

Cited by 13 publications

References 209 publications

Diagnostic performance of the gallbladder reporting and data system combined with color doppler flow imaging for gallbladder cancer in the Asian population

Diagnostic performance of the gallbladder reporting and data system combined with color doppler flow imaging for gallbladder cancer in the Asian population

An approach to managing gallbladder polyps for the general practitioner

Contemporary diagnosis and management of gallbladder polyps

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