Polypoid lesions of gallbladder: Is accurate diagnosis possible preoperatively?

Abstract

Aim. The aim of this study was to determine the accuracy of ultrasonography in diagnosing polyps. In this report 34 cases in 775 cholecystectomies which have preoperative ultrasonographic (US) diagnosis of PG or PLG were analysed retrospectively, by correlating post cholecystectomy histopathological findings with the preoperative ultrasonography. Methods. Initial diagnosis of each patient with polyp was confirmed by ultrasonography. Retrospective analysis of the symptoms, coexisting biliary pathologies, radiological findings (polyp number, size and natures), and type of surgery, surgical indications, pathological diagnosis were made. Histopathologic analysis of gallbladder was performed in all patients. Preoperative ultrasonographic diagnosis and postoperative patholological diagnosis were compared for each patient. If there were any discordance, we discussed the false positive results of preoperative US. and our surgical approach to the gallbladder polyps, under the knowledge of current literature Results. For US examination true positivity and false positivity rates were 14/34 (41.17%), 20/34 (58.82%). Mean polyp size was 10.93±53 mm (range 5-25). Polyps under 10 mm in size determined by US ratio was 82.35 % (28/34). The rate of multiple polyps determined by US was 61.7 % and the rate of single polyps was 38.23%. Thirty one patients had laparoscopic cholecystectomy. The patient with malignant polyp had open cholecystectomy. In two patients conversion to open surgery was necessary. Conclusion. There are difficulties in the diagnosis and management of PLGs and PGs. Although in one patient malignancy of gallbladder was diagnosed preoperatively by US, in our study ultrasonography was not completely accurate in differentiating polyps true or cholestrerolosis. Once a polypoid lesion determined by US, the other accompaning pathologies such as gallbladder stones, cholesterolosis, cholesterol polyps and cholecystitis, should be keep in mind that they are usually misdiagnosed as true polyps. Importance given that true polyps was that their potential malignancy risk, so if there is any suspicion of malignancy further alternative diagnostic modalities should apply besides US examination.