{"entity":{"id":"paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019","kind":"paper","name":"Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps","aka":[],"tldr":"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.","asOf":"2026-09-24","links":[{"label":"Surg Endosc 2019","url":"https://doi.org/10.1007/s00464-018-6444-1"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30203209/"}],"tags":["gallbladder-evidence"],"related":[],"cancers":["gallbladder"],"sections":[],"technologies":["ultrasound"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["gallbladder-polyp","overdiagnosis"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"Surgical Endoscopy","year":2019,"doi":"10.1007/s00464-018-6444-1","pmid":"30203209","authors":"Wennmacker SZ, van Dijk AH, Raessens JHJ, et al.","paperType":"observational","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."],"whatItMeans":"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."],"changedPractice":false,"participants":2085},"route":"/key-papers/paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019/","neighbours":{"cancer":[{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"}],"technology":[{"id":"ultrasound","kind":"technology","name":"Ultrasound","route":"/technologies/ultrasound/"}],"term":[{"id":"gallbladder-polyp","kind":"term","name":"Gallbladder polyp (polypoid lesion)","route":"/terms/gallbladder-polyp/"},{"id":"overdiagnosis","kind":"term","name":"Overdiagnosis","route":"/terms/overdiagnosis/"}]}}