Explore the vast range of titles available.

Background and Aim Gallbladder polypoid-lesions (GPs) are commonly seen on ultrasonography (USG), but several aspects of this problem are ill-defined. This study aimed to analyze clinic and pathologic characteristics of 1446 USG-detected GPs, identify predictive factors for cholesterol lesions and malignancy, and provide comments and recommendations on specific aspects of GPs. Methods We retrospectively analyzed clinic files of 1446 patients who underwent cholecystectomy for USG-detected GPs between 2008 and 2015 in Gallbladder Diseases Center, East Hospital of Tongji University. Results For the 1446 patients, the F: M ratio and the mean age were 1.06: 1 and 45 years, and most of them were asymptotic (80.3%) and had multiple polyps (62.5%). All the 1446 GPs were classified into three categories: cholesterol, benign non-cholesterol, and malignant lesions, with respective proportion of 87.1% (1260), 11.2% (162), and 1.7% (24). Over half of benign non-cholesterol lesions, of which most were premalignant neoplasm (adenoma), were less than 10 mm. Multiple number and the presence of lipid abnormalities were significantly more associated with cholesterol than non-cholesterol lesions, with odd ratios (OR) of 2.9 ( P  < 0.001) and 1.6 ( P  = 0.023), respectively. Age ≥50 years, present symptoms, size ≥10 mm and concurrent gallstones were independent predictive factors to discriminate malignant polyps from premalignant lesions, with ORs of 16.5 ( P  < 0.001), 6.3 ( P  = 0.013), 41.5 ( P  = 0.014), and 18.0 ( P  = 0.002), respectively. Conclusions According to our proposed classification, the vast majority of GPs were cholesterol lesions without malignant potential and associating with metabolic diseases. We strongly recommend that risk factors of GPs be investigated by subtypes, and patients with GPs be treated with personalized and differentiated strategies.

Background Recently, the clinical application of diffusion-weighted magnetic resonance imaging (DWI) has been expanding to abdominal organs. However, only a few studies on gallbladder diseases have been published. The aim of this study was to evaluate the usefulness and limitations of high b-value DWI for gallbladder diseases. Methods A total of 153 patients (mean age 60 ± 15 years, 78 males) who had undergone DWI for evaluating gallbladder wall thickening or polypoid lesions were included in this study. Of these 153 patients, 36 had gallbladder cancer and 117 had benign gallbladder diseases (67 chronic cholecystitis, 44 adenomyomatosis, four cholesterol polyp, one gallbladder adenoma, and one xanthogranulomatous cholecystitis). We evaluated the positive signal rate with DWI and the apparent diffusion coefficient (ADC) value of each disease. Results The positive signal rate with DWI was significantly higher in gallbladder cancer (78 %) than in benign gallbladder diseases (22 %) ( p  < 0.001). The mean ADC value of gallbladder cancer was (1.83 ± 0.69) × 10 −3  mm 2 /s and that of benign gallbladder diseases was (2.60 ± 0.54) × 10 −3  mm 2 /s ( p  < 0.001). Benign gallbladder diseases with acute cholecystitis or a history of that had a higher positive signal rate with DWI ( p  < 0.001) and a lower ADC value ( p  = 0.018) than those without such conditions. Conclusion DWI can contribute to the improvement of the diagnostic capability for gallbladder wall thickening or polypoid lesions by compensating for weaknesses of other modalities by its many advantages, although cases with acute cholecystitis or such history sometimes show false-positive on DWI.

Purpose To verify whether radiomics techniques based on dual-modality ultrasound consisting of B-mode and superb microvascular imaging (SMI) can improve the accuracy of the differentiation between gallbladder neoplastic polyps and cholesterol polyps. Methods A total of 100 patients with 100 pathologically proven gallbladder polypoid lesions were enrolled in this retrospective study. Radiomics features on B-mode ultrasound and SMI of each lesion were extracted. Support vector machine was used to classify adenomas and cholesterol polyps of gallbladder for B-mode, SMI and dual-modality ultrasound, respectively, and the classification results were compared among the three groups. Results Six, eight and nine features were extracted for each lesion at B-mode ultrasound, SMI and dual-modality ultrasound, respectively. In dual-modality ultrasound model, the area under the receiver operating characteristic curve (AUC), classification accuracy, sensitivity, specificity, and Youden’s index were 0.850 ± 0.090, 0.828 ± 0.097, 0.892 ± 0.144, 0.803 ± 0.149 and 0.695 ± 0.157, respectively. The AUC and Youden’s index of the dual-modality model were higher than those of the B-mode model ( p  < 0.05). The AUC, accuracy, specificity and Youden’s index of the dual-modality model were higher than those of the SMI model ( p  < 0.05). Conclusions Radiomics analysis of the dual-modality ultrasound composed of B-mode and SMI can improve the accuracy of classification between gallbladder neoplastic polyps and cholesterol polyps.

Background Gallbladder cholesterol polyp (GCP) and gallbladder adenoma (GA) are easily confused in clinical diagnosis. This study aims to establish a nomogram prediction model for preoperative prediction of the risk of GA patients. Study design We retrospectively collected clinical data of GCP or GA patients who underwent laparoscopic cholecystectomy (LC) between January 2020 and April 2023. We compared and analyzed the differences between the GCP group and the GA group. The data were divided into a training set and a validation set in a 7:3 ratio. Independent risk factors were determined using LASSO and Logistic regression analysis, and a nomogram model was established. The model was comprehensively validated and evaluated using the area under the ROC curve (AUC), Hosmer–Lemeshow test and clinical decision curve analysis (DCA). Results This study ultimately included 497 patients. The independent predictors of the nomogram model include blood type (O-type blood, OR 2.00, 95% CI 1.02–3.94; P  = 0.046), number of lesions (solitary, OR 2.11; 95% CI 1.08–4.12; P  = 0.033), sessile polyp (OR 2.04; 95% CI 1.06–3.92; P  = 0.033), age (OR 1.10; 95% CI 1.07–1.20; P  < 0.001), diameter (OR 1.30; 95% CI 1.17–1.45; P  < 0.001). For the training and validation set, the area under the ROC curve (AUC) was 0.843 and 0.837, respectively, and the P -value for the Hosmer–Lemeshow test was 0.056 and 0.300, respectively. In addition, the calibration curve and DCA curve indicate that the model has accurate predictive ability and reliable clinical practicality. Conclusions The blood type, number of lesions, sessile polyp, age and diameter are significant risk factors for GA. This nomogram model can use simple and readily available clinical data to predict the risk of having GA and can assist in guiding surgical decisions. Graphical abstract

PurposeTo develop and validate a novel method based on radiomics for the preoperative differentiation of benign and malignant gallbladder polypoid lesions (PLG).Patients and methodsA total of 145 patients with pathological proven gallbladder polypoid lesions ≥ 1 cm were included in this retrospective study. All the patients underwent abdominal contrast-enhanced computed tomography (CT) examinations 3 weeks before cholecystectomy from January 2013 to January 2019. Seventy percent of the cases were randomly selected for the training dataset, and 30% of the cases were independently used for testing. Radiomics features extracted from portal venous-phase CT of the PLG and clinical features were analyzed, and the LASSO regression algorithm was used for data dimension reduction. Multivariable logistic regression was used to generate radiomics signatures, clinical signatures, and combination signatures. The receiver operating characteristic (ROC) curve and decision curve were plotted to assess the differentiating performance of the three signatures.ResultsThe area under the ROC curve (AUC) of the radiomics signature and clinical signature was 0.924 and 0.861 in the testing dataset, respectively. For the radiomics signature, the accuracy was 88.6%, with 88.0% specificity and 89.5% sensitivity. When combined, the AUC was 0.931, the specificity was 84.0%, and the sensitivity was 89.5%. The differences between the AUC values of the two sole models and the combination model were statistically nonsignificant.ConclusionRadiomics based on CT images can be helpful to differentiate benign and malignant gallbladder polyps ≥ 1 cm in size.

Background Polypoid lesions of the gallbladder (PLG) are common, and most are benign. Few lesions are found to be malignant, but are not preoperatively distinguished as such using common imaging modalities. Therefore, we compared characteristics of benign and malignant PLGs in depth. Methods We enrolled 1204 consecutive patients diagnosed with PLG at Taipei Veterans General Hospital between January 2004 and December 2013. Patients underwent either surgery or regular follow-up with various imaging modalities for at least 24 months. The mean follow-up duration was 72 ± 32 months. Results Of 1204 patients, 194 underwent surgical treatment and 1010, regular follow-up. In addition, 73 % patients were asymptomatic. The mean PLG size was 6.9 ± 7.7 (range 0.8–129) mm; the PLGs of 337 patients (28 %) grew during their follow-up periods. The majority of PLGs (90.4 %) were single lesions, and 10.5 % of patients had associated gallstones. The PLGs of 20.1 % of surgical patients were malignant. Malignant PLGs were found in 32.4 % of patients ≥50 years old and in 4.7 % of those <50 years old ( p  < 0.001). Right quadrant abdominal pain, epigastric pain, and body weight loss were the three most common symptoms associated with malignancy. Malignant PLGs were significantly larger than benign lesions (means: 27.5 ± 18.4 mm vs. 12.3 ± 12.3 mm, respectively, p  < 0.001). Notably, the size of 5 % of malignant PLGs was 3–5 mm, and that of 8 % was 5–10 mm. The negative predictive value for gallbladder malignancy was 92.8 % based on a size ≥10 mm and 100 % based on a size ≥3 mm. Conclusions Our study reassesses the PLG size that warrants more aggressive intervention. Cholecystectomy remains mandatory for PLGs > 10 mm, but should also be considered a definitive diagnostic and treatment modality for PLGs with diameters of 3–10 mm.

Background Metastasis of renal cell carcinoma (RCC) to the gallbladder is rare, and its clinicopathological feature remains poorly understood. We here present two cases of gallbladder metastasis from RCC presenting as a hypervascular polypoid lesion. Case presentation The first case was a 73-year-old man who had undergone right nephrectomy for clear cell RCC. Imaging studies detected a hypervascular polypoid lesion in the gallbladder 6 years after nephrectomy. Laparoscopic cholecystectomy was done. The pathological findings of the polypoid lesion showed proliferation of clear cells in the submucosal layer. Immunohistochemically, the tumor was positive for carbonic anhydrase 9 (CA9) but negative for cytokeratin 7 (CK7), suggestive of metastatic RCC. The second case was a 43-year-old man who had undergone right nephrectomy for clear cell RCC. Imaging studies revealed a hypervascular polypoid lesion of 20 mm in diameter in the gallbladder 1 year after nephrectomy. The patient underwent expanded cholecystectomy and extra-hepatic bile duct resection with lymphadenectomy. Microscopically, the polypoid lesion of the gallbladder was composed of clear cells in the submucosal layer. Immunohistochemical analysis showed positive staining for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) but negative staining for CK7, leading to the diagnosis of metastatic RCC. Conclusions Gallbladder metastasis from RCC is rare but should be considered when a hypervascular polypoid lesion in the gallbladder is detected during the follow-up period after RCC treatment.

The aim of this study was to investigate the differences between images of large adenoma of the gallbladder and the protruding type carcinoma of the gallbladder. A retrospective study was performed on 130 patients who underwent cholecystectomy or biopsy for gallbladder polypoid lesions larger than 10 mm; among them, 20 patients were malignant and 110 patients were benign. Patients' details including ultrasonography (US), computed tomography (CT) and magnetic resonance (MR) findings were analyzed. All patients whose lesions were >15 mm by US, had CT or MR scans to further determine the nature of the lesion; two patients who were suspected to have a malignant lesion due to their large tumor size were benign by histological examination. Distinct differences were found between large adenoma and protruding type of gallbladder carcinoma. There were distinct differences between adenomas and the protruding type gallbladder cancers, and there was a pathological basis for the differences. Benign tumors had a more homogeneous texture, had spaces between the tumor and the gallbladder wall and a relatively normal configuration of the gallbladder wall. Based on these findings, certain lesions could be definitively diagnosed as benign adenomas and could help in treatment strategy.

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.

We have previously reported the effectiveness of endoscopic ultrasonography (EUS) for the differential diagnosis of pedunculated polypoid lesions of the gallbladder, based on retrospective studies using resected specimens. We proposed the following diagnostic criteria for EUS findings: when the contour of a lesion is nodular or smooth, the lesion is diagnosed as a neoplasm, and when a lesion has a granular contour, it is diagnosed as a nonneoplasm. The present study was designed to verify the clinical utility of our EUS ctiteria prospectively. Forty-six consecutive patients with pedunculated polypoid lesions of the gallbladder 10mm or greater in size diagnosed as nonneoplasms at the initial EUS, all of whom underwent follow-up examinations, were enrolled in this study. The occurrence of changes in these lesions during the observation period was examined. No evident changes in lesions were observed in 43 of the 46 patients. Spontaneous self-detachment of lesions was recognized during the observation period in the other 3 patients. EUS is useful for determining treatment indications for pedunculated polypoid lesions of the gallbladder, even when the lesions are large, and contributes to avoiding unnecessary surgery.