Outcome of gall bladder polypoidal lesions detected by transabdominal ultrasound scanning: a nine year experience.
OBJECTIVE
To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning.


METHODS
A nine-year (1993-2002) retrospective case-note review of all patients who underwent ultrasound scanning after referral to a single Upper GI Surgeon at a District General Hospital was conducted. Patients who were diagnosed with a PLG were included in our study. A database was constructed and patient details, investigations including ultrasound scan (USS) findings, treatment and histology and final diagnosis were recorded.


RESULTS
Twenty-three (out of 651) patients were diagnosed pre-operatively by USS to have a polyp-like gall bladder lesion (PLG). Post cholecystectomy histological examination revealed 12 gallstones, 7 cholesterol polyps, 3 adenocarcinomas within polyps and 1 normal gall bladder. The specificity of USS in the diagnosis of PLG was 92.3%. All the true polyps were malignant. Overall USS had 66.66% sensitivity and 100% specificity in the pre-operative suspicion of malignancy. Using size greater than 10 mm as measured on USS as a cut-off, we find 100% sensitivity and 86.95% specificity with a positive predictive value of 50% in the diagnosis of malignancy in PLG.


CONCLUSIONS
A large number of PLG are in fact calculi within diseased gall bladder. In cases of gall bladder polyps more then 10 mm in size on USS further imaging (cross-sectional and/or EUS) is indicated prior to surgery. This will help in the optimal management of patients and avoid histological surprises.
Chattopadhyay
D
D
Hepatopancreatobiliary Surgery Unit, Freeman Hospital, Newcastle upon Tyne, NE34 0PL, UK.
Lochan
R
R
Balupuri
S
S
Gopinath
B-R
BR
Wynne
K-S
KS
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography