Gallbladder Polypoid-Lesions: What Are They and How Should They be Treated? A Single-Center Experience Based on 1446 Cholecystectomy Patients

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.

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.

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.

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.