2 mm size change on screening gallbladder polyps as basis of cholecystectomy too conservative: Study
Leesburg, VA -Recent European multisociety guidelines recommend routine follow-up imaging of gallbladder polyps (including polyps <6 mm in patients without risk factors) and size change of ≥2 mm to prompt cholecystectomy.
Researchers have found in a new study that Gallbladder polyps fluctuate in size, number, and visibility over serial examinations. Using 2 mm threshold for growth, 10% increased in size but no carcinoma was identified.
Therefore surveillance and serial ultrasound examinations of essentially all polyps and a 2 mm size change as basis for cholecystectomy are likely too conservative for clinical application.
The researchers conducted a study to assess longitudinal changes in the number and size of gallbladder polyps on serial ultrasound examinations.
The retrospective study included patients who underwent at least one screening ultrasound examination between January 2010 and December 2020 as part of a hepatocellular carcinoma screening and surveillance program that demonstrated a gallbladder polyp. Number of polyps and size of largest polyp were recorded based primarily on review of examination reports. Longitudinal changes on serial examinations were summarized. Pathologic findings from cholecystectomy were reviewed
"To our knowledge," wrote corresponding author Aya Kamaya of Stanford Hospital and Clinics in California, "our study is the first conducted in the United States to longitudinally evaluate gallbladder polyps exclusively in patients with underlying liver disease."
Kamaya and colleagues' retrospective study included patients who underwent at least one screening ultrasound examination between January 2010 and December 2020, as part of a hepatocellular carcinoma (HCC) screening and surveillance program that demonstrated a gallbladder polyp.
This retrospective study included patients who underwent at least one screening ultrasound examination between January 2010 and December 2020 as part of a hepatocellular carcinoma screening and surveillance program that demonstrated a gallbladder polyp. Number of polyps and size of largest polyp were recorded based primarily on review of examination reports. Longitudinal changes on serial examinations were summarized. Pathologic findings from cholecystectomy were reviewed.
Acknowledging that gallbladder polyps can fluctuate in both size and number over serial examinations, and may even fluctuate in visibility, "using a 2 mm threshold for growth," the authors of this AJR article concluded, "10% increased in size."
