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Imaging based flowchart for gallbladder polyp evaluation
- Source :
- Journal of Medical Imaging and Radiation Sciences, 52, 1, pp. 68-78, Journal of Medical Imaging and Radiation Sciences, 52, 68-78
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Contains fulltext : 232906.pdf (Publisher’s version ) (Open Access) BACKGROUND: Preoperative differentiation between neoplastic and nonneoplastic gallbladder polyps, and the subsequent indication for cholecystectomy remains a clinical dilemma. The current 1 cm size threshold for neoplasia is unspecific. The aim of this study was to improve diagnostic work-up for gallbladder polyps using sonographic and MRI characteristics of neoplastic and nonneoplastic polyps. METHODS: A prospective, exploratory study including patients undergoing cholecystectomy for gallbladder polyp(s) was conducted. Patients underwent targeted transabdominal ultrasound (TAUS) and MRI. Outcomes were sensitivity and specificity for polyp diagnosis, and the radiological characteristics of neoplastic and nonneoplastic polyp types. Histopathology after cholecystectomy was used as reference standard. RESULTS: Histopathology demonstrated gallbladder polyps in 20/27 patients (74%): 14 cholesterol polyps, three adenomyomatosis, two adenomas and one gastric heterotopia. Sensitivity of polyp identification were 72% (routine TAUS) and 86% (targeted TAUS and MRI). Both adenomas were identified as neoplastic on targeted TAUS and MRI. Sonographic presentation as multiple, pedunculated polyps, either heterogeneous or with hyperechoic foci, or as single polyps containing cysts were limited to nonneoplastic polyps. On MRI hyperintense polyps on T1-weighted image were cholesterol polyps. An adenoma with high-grade dysplasia showed foci of decreased ADC values. We propose a checklist for polyp evaluation by targeted TAUS and a flowchart for radiological work-up of gallbladder polyps. CONCLUSIONS: The presented checklist and flowchart could aid diagnostic work-up for gallbladder polyps compared to current routine ultrasound, by elimination of nonneoplastic polyps and ultimately improve treatment decision for patients with gallbladder polyps.
- Subjects :
- Male
medicine.medical_specialty
Adenoma
medicine.medical_treatment
Contrast Media
Gallbladder Diseases
Sensitivity and Specificity
030218 nuclear medicine & medical imaging
Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14]
03 medical and health sciences
Meglumine
Polyps
0302 clinical medicine
Image Interpretation, Computer-Assisted
Gallbladder polyp
Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14]
Organometallic Compounds
otorhinolaryngologic diseases
medicine
Humans
Cholecystectomy
Radiology, Nuclear Medicine and imaging
Prospective Studies
neoplasms
Netherlands
Ultrasonography
Adenomyomatosis
Radiological and Ultrasound Technology
medicine.diagnostic_test
business.industry
Gallbladder
Magnetic resonance imaging
pathological conditions, signs and symptoms
Middle Aged
medicine.disease
Magnetic Resonance Imaging
digestive system diseases
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11]
surgical procedures, operative
medicine.anatomical_structure
Dysplasia
030220 oncology & carcinogenesis
Female
Histopathology
Radiology
business
Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Subjects
Details
- ISSN :
- 19398654
- Volume :
- 52
- Database :
- OpenAIRE
- Journal :
- Journal of Medical Imaging and Radiation Sciences
- Accession number :
- edsair.doi.dedup.....5d57b76eb98469c126b2d5666c2b6bda
- Full Text :
- https://doi.org/10.1016/j.jmir.2020.12.003