Overtreatment of Nonneoplastic Gallbladder Polyps due to Inadequate Routine Ultrasound Assessment

Abstract

<b><i>Background:</i></b> The primary aim was to assess the diagnostic accuracy of routine ultrasound assessment for gallbladder polyps. The secondary aim was to identify the characteristics that differentiate neoplastic polyps from nonneoplastic polyps. <b><i>Methods:</i></b> A total of 156 patients with histopathologically proven gallbladder polyps in 4 Dutch hospitals between 2003 and 2013 were included. Sensitivity and specificity of ultrasound for polyp size, number of polyps, and polyp type were assessed using histopathological findings as a reference standard. In addition, diagnostic accuracy of sonographic size ≥1 cm for neoplasia was assessed. Subgroup analysis for patients with polyps as primary indication for cholecystectomy was performed. The sonographic polyp characteristics on preoperative routine ultrasound were described. <b><i>Results:</i></b> Fifty-six percent of gallbladder polyps were preoperatively identified on ultrasound, of which 31% were neoplastic. Sensitivity and specificity of ultrasound to estimate polyp size were 93 and 43% (subgroup; 92 and 33%). Sensitivity and specificity of sonographic polyp size ≥1 cm for neoplasia were 86 and 32% (subgroup; 94 and 26%). No specific sonographic characteristics for neoplastic polyps could be established due to lack of reporting. <b><i>Conclusion:</i></b> Routine ultrasound assessment of polyps is associated with overestimation of polyp size and low specificity of sonographic size ≥1 cm for neoplasia, which contributes to surgical overtreatment of nonneoplastic polyps.

Influence of Comprehensive Nursing Intervention Combined with WeChat Platform Propaganda and Education of ERAS Concept on Postoperative Functional Recovery of Patients with Gallbladder Polyps

“…Wennmacker et al thought that ERAS's concept combined with comprehensive nursing intervention can change the traditional concept of medical staff and provide comprehensive, systematic, meticulous, and patient nursing services for patients, enabling remarkable recovery effects of intestinal peristalsis. The time to get out of bed and exhaust was shortened significantly, the incidence of adhesive ileus was significantly reduced, and the patients fully mastered the health 2 Scanning education content, so that the satisfaction of nursing work will be significantly improved, which is worthy of continuous promotion and application in clinical work [13].…”

Gallbladder Polyp Classification in Ultrasound Images Using an Ensemble Convolutional Neural Network Model

“…However, this value is not sufficient to differentiate neoplastic polyps. According to a recent study, when cholecystectomy was performed with a 10 mm criterion, approximately 40% of the patients had non-neoplastic (pseudo) polyps and did not require cholecystectomy [21]. In the present study, the diagnostic accuracy of the model, when the size factor was not included, was approximately 84%, indicating that the size factor is not absolutely crucial.…”

Gallbladder polyps and the challenge of distinguishing benign lesions from cancer

“…However, available studies report only univariate analysis of these morphological features. 5,[13][14][15] Firm conclusions about the risk of malignancy are therefore difficult to draw.…”

“…Hyperechoic internal pattern or foci are more common in cholesterol polyps and would prevent cholecystectomy and futile follow‐up. However, available studies report only univariate analysis of these morphological features 5,13–15 . Firm conclusions about the risk of malignancy are therefore difficult to draw.…”