Pathological and Ultrasonographic Concordance of Gallbladder Polyps Following Cholecystectomy

Abstract

Introduction: Gallbladder polyps are mucosal projections into the gallbladder lumen, often detected incidentally during ultrasonography or after cholecystectomy. While most are benign, some carry a risk of malignant transformation. This study aimed to evaluate the diagnostic sensitivity of preoperative ultrasonography in detecting gallbladder polyps confirmed by postoperative pathological analysis. Material and Methods: A retrospective review was conducted on patients who underwent cholecystectomy between October 2021 and March 2024 at Erzurum Regional Training and Research Hospital. Pathology reports were examined to identify gallbladder polyps. Patients with malignancy-related surgeries or missing ultrasonography data were excluded. Polyps were classified by size as small (1–5 mm), medium (6–9 mm), and large (≥10 mm). Ultrasonographic findings were compared with pathology results, and data were analyzed using SPSS version 22. Results: Among 3,230 cholecystectomies, 87 patients had gallbladder polyps, and 70 met the inclusion criteria. The mean age was 47.8 years, and the female-to-male ratio was 1.52. Pathologically, 58 patients had small, 5 had medium, and 7 had large polyps. Preoperative ultrasonography identified polyps in only 25 of 56 patients (sensitivity: 45%). Among patients with polyps ≥6 mm (n=11), only 5 were identified preoperatively. For polyps ≥10 mm (n=6), only 2 were correctly detected. Discussion: The sensitivity of ultrasonography for detecting gallbladder polyps in this study was lower than reported in the literature. Particularly concerning was the misdiagnosis of polyps ≥10 mm, which pose a higher risk for malignancy. These findings emphasize the need for heightened vigilance and systematic evaluation in ultrasonographic assessments, especially in high-risk patients.

Keywords

• Gallbladder polyps
• Cholecystectomy
• Ultrasonography

Kolesistektomi Sonrası Safra Kesesi Poliplerinin Patolojik ve Ultrasonografik Uyumu

Öz

Giriş: Safra kesesi polipleri, safra kesesi lümenine doğru uzanan mukoza çıkıntılarıdır ve sıklıkla ultrasonografi sırasında ya da kolesistektomi sonrası patolojik incelemelerde tesadüfen saptanırlar. Çoğunluğu benign olmakla birlikte, bazı polipler malign dönüşüm riski taşımaktadır. Bu çalışmanın amacı, patolojik olarak doğrulanan safra kesesi poliplerinin preoperatif ultrasonografi ile saptanmasındaki tanısal duyarlılığı değerlendirmektir. Gereç ve Yöntemler: Ekim 2021 ile Mart 2024 tarihleri arasında Erzurum Bölge Eğitim ve Araştırma Hastanesi’nde kolesistektomi uygulanan hastalar retrospektif olarak incelendi. Patoloji raporları gözden geçirilerek safra kesesi polibi saptanan hastalar belirlenmiştir. Malignite nedeniyle ameliyat edilenler ve ultrasonografi verilerine ulaşılamayan hastalar çalışma dışı bırakılmıştır. Polipler; küçük (1–5 mm), orta (6–9 mm) ve büyük (≥10 mm) olarak sınıflandırılmıştır. Ultrasonografi bulguları patoloji sonuçları ile karşılaştırılmış ve veriler SPSS 22 programı kullanılarak analiz edilmiştir. Sonuç: 3.230 kolesistektomi olgusu arasında 87 hastada safra kesesi polibi saptanmış, 70 hasta çalışmaya dahil edilmiştir. Ortalama yaş 47,8 olup kadın/erkek oranı 1,52 olarak bulunmuştur. Patolojik incelemelerde 58 hastada küçük, 5 hastada orta, 7 hastada büyük polip saptanmıştır. Preoperatif ultrasonografide 56 hastanın 25’inde polip saptanmış olup duyarlılık %45 olarak bulunmuştur. 6 mm ve üzeri polip saptanan 11 hastanın yalnızca 5’inde, 10 mm ve üzeri polip bulunan 6 hastanın ise sadece 2’sinde preoperatif olarak polip tanısı konulabilmiştir. Tartışma: Bu çalışmada ultrasonografinin safra kesesi poliplerini saptamadaki duyarlılığı literatürde bildirilen oranlardan daha düşük bulunmuştur. Özellikle malignite riski yüksek olan 10 mm ve üzeri poliplerin yanlış değerlendirilme oranının yüksek olması dikkat çekicidir. Bulgular, yüksek riskli hastalarda daha dikkatli ve sistematik bir ultrasonografi değerlendirmesinin gerekliliğini ortaya koymaktadır.

Anahtar Kelimeler

• Safra kesesi polipleri
• Kolesistektomi
• Ultrasonografi

Kaynakça

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