title: Gallbladder lesions identified on ultrasound. Lessons from the last 10 years.
abstract: BACKGROUND
  Possible mass lesions identified on ultrasound (US) of the gallbladder may prompt an aggressive surgical intervention due to the possibility of a malignant neoplasm.
  
  
  OBJECTIVE
  This study aims to utilize a large modern series of patients with gallbladder lesions identified on US to evaluate imaging characteristics consistent with malignancy.
  
  
  METHODS
  A retrospective review was conducted of gallbladder ultrasound reports and clinicopathologic data of patients with a mass identified on US.
  
  
  RESULTS
  Approximately 59,271 abdominal ultrasounds and 9,117 cholecystectomies were performed between February 2000 and February 2010. We identified 213 patients with a questionable gallbladder neoplasm on ultrasonography who underwent surgical exploration. Median age was 52 years (range=11-87 years) and 147 (69%) were females. Final pathology demonstrated no neoplasm in 130 patients (61%), while 32 patients (15%) had a wall adenomyoma, 36 (17%) had a polyp (five of which were malignant), 14 (7%) had an adenocarcinoma not arising from a polyp, and one patient had a cystic papillary neoplasm. The smaller the lesion, the more likely it was to be a pseudo-mass. For lesions measuring <5 mm on US, 83% had no lesion found on final pathology. Significant predictors of malignancy were age >52 years (p<0.001), presence of gallstones on US (p=0.004), size >9 mm (p<0.001), evidence of invasion at the liver interface (p<0.001), and wall thickening >5 mm (p<0.001). Shape (sessile or penduculated), echogenicity (echogenic or isoechoic), or presence of flow on Doppler were not predictors of malignancy. An US size of ≤ 9 mm had a negative predictive value of 100% for malignancy.
  
  
  CONCLUSIONS
  Despite improvements in imaging, most apparent lesions measuring <5 mm on US are not identified in the surgical specimen. US size >9 mm, age >52 years, US suggestion of invasion at the liver interface, and wall thickening >5 mm, especially in the presence of gallstones, should raise the suspicion of malignancy.
authors: Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Ioannis T
authors: IT
authors: Konstantinidis
authors: Surabhi
authors: S
authors: Bajpai
authors: Avinash R
authors: AR
authors: Kambadakone
authors: Kenneth K
authors: KK
authors: Tanabe
authors: David L
authors: DL
authors: Berger
authors: Hui
authors: H
authors: Zheng
authors: Dushyant V
authors: DV
authors: Sahani
authors: Gregory Y
authors: GY
authors: Lauwers
authors: Carlos
authors: C
authors: Fernandez-del Castillo
authors: Andrew L
authors: AL
authors: Warshaw
authors: Cristina R
authors: CR
authors: Ferrone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002763:Cholecystectomy; D041761:Cholecystolithiasis / Q000000981:diagnostic imaging / Q000601:surgery; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; 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; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult