Scientific paper
Differential diagnosis of polypoid lesions of the gallbladder by endoscopic ultrasonography

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Abstract

Background: Transabdominal ultrasonography (US) has made the detection of gallbladder polyps easier, but the differential diagnosis of polyps less than 20 mm remains difficult. Therefore, we evaluated the usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of gallbladder polyps.

Methods: Among patients with gallbladder polyps less than 20 mm, we reviewed 89 patients who underwent US and EUS before surgery and assessed the results of differential diagnoses by them.

Results: In all, 86.5% of these polyps were precisely diagnosed by EUS. However, only 51.7% were diagnosed by US. Sensitivity, specificity, and positive and negative predictive values of EUS at the diagnosis of carcinoma were 91.7%, 87.7%, 75.9%, and 96.6%, respectively. Those of US were 54.2%, 53.8%, 54.2%, and 94.6%, respectively.

Conclusions: EUS may markedly improve the accuracy of the differential diagnosis of gallbladder polyps. Therefore, EUS is thought to play an important role in determining the treatment strategy for gallbladder polyps.

Section snippets

Patients and methods

Among patients who underwent surgery for gallbladder polyps less than 20 mm in maximal diameter at the Department of Gastroenterological Surgery, Tokyo Women’s Medical University, from 1989 to 1998, 89 patients who underwent US and EUS before surgery were included in this study. US was performed as an abdominal screening test for asymptomatic patients or detailed examination for patients suspected of having a gastrointestinal disorder because of clinical symptoms. In cases where US detected

Relation between histological diagnosis and maximal diameter of polypoid lesions

The relation between histological diagnosis and maximal diameter of polypoid lesions was studied (Table 1). Eighteen of 24 cancer lesions (75%) were more than 10 mm in maximal diameter. However, 31 of 65 benign lesions (47.7%) also exceeded 10 mm. Even in cholesterol polyps, 18 of 50 lesions (36%) were over 10 mm in diameter. The prevalence of carcinoma in the lesions more than 10 mm in diameter was 36.7% (18 of 49), which was equal to that of cholesterol polyp.

Differential diagnosis by EUS

EUS precisely identified

Comments

US can demonstrate various polypoid lesions of the gallbladder. However, the differential diagnosis of polypoid lesions less than 20 mm remains difficult in many cases. A number of papers have reported that malignancy should be considered when the polypoid lesion exceeds 10 mm in diameter [7], [8], [9], [10], [11]. However, our results showed that it was very difficult to differentiate gallbladder polyps based on the size of lesions. Diagnostic imaging techniques other than EUS and US, such as

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