Lodhi A, Waite K, Alam I
Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK.
Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK.
Radiography (Lond). 2020 May;26(2):e52-e55. doi: 10.1016/j.radi.2019.10.010. Epub 2019 Nov 11.
Gallbladder polyps (GBPs) are gallbladder lesions which can progress to gallbladder malignancy. The incidence has been estimated as high as 12.1% of all cholecystectomy patients. Gallbladder malignancy typically presents late, and therefore carries a poor prognosis. By identifying potential GBPs early, it would be possible to treat polyps before they undergo malignant change. The current gold standard for GBP identification is with histological examination which is performed after cholecystectomy. This study sought to assess whether radiological imaging could reliably identify GBPs and therefore guide management.
1000 consecutive patients already undergoing cholecystectomy were sampled from two UK hospitals. Patients who underwent ultrasonography and had histological analysis of their gallbladders were selected. Overall 905 patients were included in the study.
There were 12 histologically confirmed GBPs in the cohort (1.33%). US correctly detected 1 GBP, with a sensitivity of 8.3% (95% CI 0.2-38.5%) and specificity of 96.0% (95% CI 94.5-97.2%). The overall accuracy was 94.8 (95% CI 93.2-96.2%).
These data show that US is an ineffective tool for GBP identification. The lack of prior operator exposure, imprecise nature of US and possible obstruction of images from underlying gallstone disease delivered a high rate of false positives.
Surgical or oncological decisions regarding GBPs should not be based upon US findings alone as this would lead to unnecessary interventions. MRI should be investigated as an alternative imaging modality for GBP identification, as its differentiation of soft tissues could guide surgical management.
胆囊息肉（GBP）是胆囊病变，可发展为胆囊恶性肿瘤。据估计，在所有胆囊切除术患者中，其发病率高达12.1%。胆囊恶性肿瘤通常出现较晚，因此预后较差。通过早期识别潜在的胆囊息肉，有可能在息肉发生恶变之前进行治疗。目前识别胆囊息肉的金标准是胆囊切除术后进行的组织学检查。本研究旨在评估放射影像学是否能可靠地识别胆囊息肉，从而指导治疗。
从英国两家医院连续抽取1000例已接受胆囊切除术的患者。选择接受过超声检查并对胆囊进行了组织学分析的患者。共有905例患者纳入研究。
该队列中有12例经组织学证实的胆囊息肉（1.33%）。超声正确检测出1例胆囊息肉，灵敏度为8.3%（95%可信区间0.2 - 38.5%），特异度为96.0%（95%可信区间94.5 - 97.2%）。总体准确率为94.8（95%可信区间93.2 - 96.2%）。
这些数据表明，超声是一种识别胆囊息肉的无效工具。由于缺乏先前的操作者经验、超声性质不精确以及潜在胆结石疾病可能导致图像受阻，导致假阳性率较高。
关于胆囊息肉的手术或肿瘤学决策不应仅基于超声检查结果，因为这会导致不必要的干预。应研究将磁共振成像（MRI）作为识别胆囊息肉的替代成像方式，因为其对软组织的分辨能力可指导手术治疗。
