TY - JOUR
T1 - Imaging based flowchart for gallbladder polyp evaluation
AU - Wennmacker, Sarah Z.
AU - de Savornin Lohman, Elise A. J.
AU - de Reuver, Philip R.
AU - Drenth, Joost P. H.
AU - van der Post, Rachel S.
AU - Nagtegaal, Iris D.
AU - Hermans, John J.
AU - van Laarhoven, Cornelis J. H. M.
AU - Schreinemakers, Jennifer M. J.
AU - Heisterkamp, Joos
AU - Hansson, Bibi
AU - Buyne, Otmar
AU - Nieuwenhuijs, Vincent B.
AU - Spillenaar Bilgen, Ernst Jan
AU - Collaborator group
AU - Bosscha, Koop
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: Preoperative differentiation between neoplastic and nonneoplastic gallbladder polyps, and the subsequent indication for cholecystectomy remains a clinical dilemma. The current 1 cm size threshold for neoplasia is unspecific. The aim of this study was to improve diagnostic work-up for gallbladder polyps using sonographic and MRI characteristics of neoplastic and nonneoplastic polyps. Methods: A prospective, exploratory study including patients undergoing cholecystectomy for gallbladder polyp(s) was conducted. Patients underwent targeted transabdominal ultrasound (TAUS) and MRI. Outcomes were sensitivity and specificity for polyp diagnosis, and the radiological characteristics of neoplastic and nonneoplastic polyp types. Histopathology after cholecystectomy was used as reference standard. Results: Histopathology demonstrated gallbladder polyps in 20/27 patients (74%): 14 cholesterol polyps, three adenomyomatosis, two adenomas and one gastric heterotopia. Sensitivity of polyp identification were 72% (routine TAUS) and 86% (targeted TAUS and MRI). Both adenomas were identified as neoplastic on targeted TAUS and MRI. Sonographic presentation as multiple, pedunculated polyps, either heterogeneous or with hyperechoic foci, or as single polyps containing cysts were limited to nonneoplastic polyps. On MRI hyperintense polyps on T1-weighted image were cholesterol polyps. An adenoma with high-grade dysplasia showed foci of decreased ADC values. We propose a checklist for polyp evaluation by targeted TAUS and a flowchart for radiological work-up of gallbladder polyps. Conclusions: The presented checklist and flowchart could aid diagnostic work-up for gallbladder polyps compared to current routine ultrasound, by elimination of nonneoplastic polyps and ultimately improve treatment decision for patients with gallbladder polyps.
AB - Background: Preoperative differentiation between neoplastic and nonneoplastic gallbladder polyps, and the subsequent indication for cholecystectomy remains a clinical dilemma. The current 1 cm size threshold for neoplasia is unspecific. The aim of this study was to improve diagnostic work-up for gallbladder polyps using sonographic and MRI characteristics of neoplastic and nonneoplastic polyps. Methods: A prospective, exploratory study including patients undergoing cholecystectomy for gallbladder polyp(s) was conducted. Patients underwent targeted transabdominal ultrasound (TAUS) and MRI. Outcomes were sensitivity and specificity for polyp diagnosis, and the radiological characteristics of neoplastic and nonneoplastic polyp types. Histopathology after cholecystectomy was used as reference standard. Results: Histopathology demonstrated gallbladder polyps in 20/27 patients (74%): 14 cholesterol polyps, three adenomyomatosis, two adenomas and one gastric heterotopia. Sensitivity of polyp identification were 72% (routine TAUS) and 86% (targeted TAUS and MRI). Both adenomas were identified as neoplastic on targeted TAUS and MRI. Sonographic presentation as multiple, pedunculated polyps, either heterogeneous or with hyperechoic foci, or as single polyps containing cysts were limited to nonneoplastic polyps. On MRI hyperintense polyps on T1-weighted image were cholesterol polyps. An adenoma with high-grade dysplasia showed foci of decreased ADC values. We propose a checklist for polyp evaluation by targeted TAUS and a flowchart for radiological work-up of gallbladder polyps. Conclusions: The presented checklist and flowchart could aid diagnostic work-up for gallbladder polyps compared to current routine ultrasound, by elimination of nonneoplastic polyps and ultimately improve treatment decision for patients with gallbladder polyps.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85099240501&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33422451
U2 - https://doi.org/10.1016/j.jmir.2020.12.003
DO - https://doi.org/10.1016/j.jmir.2020.12.003
M3 - Article
C2 - 33422451
SN - 1939-8654
VL - 52
SP - 68
EP - 78
JO - Journal of Medical Imaging and Radiation Sciences
JF - Journal of Medical Imaging and Radiation Sciences
IS - 1
ER -