# Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps

Source: https://onco.cc/key-papers/paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019/  
OnCo record `paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the Dutch national pathology archive fewer than one in a hundred removed gallbladders contained a polyp, more than four in ten of those polyps were harmless, and the one-centimetre rule for operating sorted them only moderately well.

## Summary

PALGA nationwide pathology registry study of all histologically proven gallbladder polyps and focal wall thickenings over 5 mm between 2003 and 2013: 2,085 of 220,612 cholecystectomies (0.9 percent). Of these, 56.4 percent were neoplastic (40.1 percent premalignant, 59.9 percent malignant) and 43.6 percent non-neoplastic (41.5 percent cholesterol polyps, 37.0 percent adenomyomatosis). Neoplastic polyps were larger (18.1 versus 7.5 mm). Clinicopathological features differed but could not reliably indicate neoplasia, and the 1 cm surgical threshold had moderate diagnostic accuracy.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: Surgical Endoscopy
- Year: 2019
- DOI: 10.1007/s00464-018-6444-1
- Authors: Wennmacker SZ, van Dijk AH, Raessens JHJ, et al.
- Findings: Polyps in 2,085 of 220,612 cholecystectomies (0.9 percent); 56.4 percent neoplastic, 43.6 percent non-neoplastic.; Mean size 18.1 mm for neoplastic vs 7.5 mm for non-neoplastic polyps.; The 1 cm threshold had moderate diagnostic accuracy for neoplasia.
- What it means: Size is a blunt tool: a 10 mm cut-off sends many people with cholesterol polyps to surgery and misses some neoplastic polyps below it. Better imaging (contrast-enhanced or endoscopic ultrasound) or a risk score is the research need the 2022 guideline itself acknowledges.
- Caveats: Only polyps that reached pathology are counted; the denominator of polyps left in place is unknown.; Size was recorded in about half of the reports.

## Sources

- Surg Endosc 2019: https://doi.org/10.1007/s00464-018-6444-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30203209/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/)
- technologies: [Ultrasound](https://onco.cc/technologies/ultrasound/)
- terms: [Gallbladder polyp (polypoid lesion)](https://onco.cc/terms/gallbladder-polyp/), [Overdiagnosis](https://onco.cc/terms/overdiagnosis/)

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