Development of Cancer in Gall Bladder Polyps Detected on Ultrasound in a High Risk Population
Objectives: Current literature regarding the assessment of changes in gall bladder polyps is minimal in Pakistan, which is known to have one of the highest risk of developing gall bladder carcinoma. The aim of this study is to determine the occurrence of cancer in incidentally detected Gall Bladder (GB) polyps identified by sonography and to propose surveillance guidelines in high risk population for gall bladder cancer.
Methods: Radiological data of all “gall bladder polyps” detected on ultrasounds done between January 2001 and February 2015 was taken at a tertiary care institution and it was evaluated to see changes in the size of GB polyps. Pathologic and clinical follow-up was reviewed from the medical record files.
Results: GB polyps from 155 patients (Age range, 18–92 years) were included. US follow-up was performed with minimum follow-up duration of 2 years. The polyps ranged in size from 2-19 mm (mean size, 4 mm). Polyp size remained unchanged in 65 (42 %) polyps, decreased in 25 (16 %), increased in 12 (7 %) and resolved in 53 (34%). None of the polyps ranging in size from 1-6 mm turned out to be neoplastic. One polyp of 7 mm showed increase in size and progressed to carcinoma.
Conclusion: The risk of malignancy of gall bladder resulting from incidentally detected polyps is very low. Hence, gall bladder polyps measuring upto 6 mm require no additional follow-up. Follow up may be indicated for polyps that are greater than or equal to 7 mm in size.
1. Corwin MT, Siewert B, Sheiman RG, Kane RA. Incidentally detected gallbladder polyps: is follow-up necessary?--Longterm clinical and US analysis of 346 patients. Radiology 2011;258:277–82. [CrossRef]
2. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 2006;118:1591–602. [CrossRef]
3. Szpakowski JL, Tucker LY. Outcomes of Gallbladder Polyps and Their Association With Gallbladder Cancer in a 20-Year Cohort. JAMA Netw Open 2020;3:e205143. [CrossRef]
4. Terzi C, Sökmen S, Seçkin S, Albayrak L, Uğurlu M. Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications. Surgery 2000;127:622–7.
5. Lee KF, Wong J, Li JC, Lai PB. Polypoid lesions of the gallbladder. Am J Surg 2004;188:186–90. [CrossRef]
6. Yang HL, Sun YG, Wang Z. Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 1992;79:227–9.
7. Csendes A, Burgos AM, Csendes P, Smok G, Rojas J. Late follow-up of polypoid lesions of the gallbladder smaller than 10 mm. Ann Surg 2001;234:657–60. [CrossRef]
8. Wiles R, Thoeni RF, Barbu ST, Vashist YK, Rafaelsen SR, Dewhurst C, et al. Management and follow-up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). Eur Radiol 2017;27:3856–66. [CrossRef]
9. Ito H, Hann LE, D'Angelica M, Allen P, Fong Y, Dematteo RP, et al. Polypoid lesions of the gallbladder: diagnosis and followup. J Am Coll Surg 2009;208:570–5. [CrossRef]
10. Mainprize KS, Gould SW, Gilbert JM. Surgical management of polypoid lesions of the gallbladder. Br J Surg 2000;87:414–7.
11. Park JY, Hong SP, Kim YJ, Kim HJ, Kim HM, Cho JH, et al. Longterm follow up of gallbladder polyps. J Gastroenterol Hepatol 2009;24:219–22. [CrossRef]
12. Kozuka S, Tsubone N, Yasui A, Hachisuka K. Relation of adenoma to carcinoma in the gallbladder. Cancer 1982;50:2226–34.