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