Nanda Bipin P, Moloney Brian M, Gershon Ariel, Kim Chelsea C Y, Elbanna Khaled Y, Jang Hyun-Jung, Liu Xiaoyang, Nowak Klaudia M, Khalili Korosh
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, Toronto, ON, Canada.
Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11826-4.
To compare the diagnostic performance of the Society of Radiologists in Ultrasound (SRU) and the 2022 Joint European Societies (JES) Guidelines regarding management at presentation of gallbladder polyps ≥ 7 mm.
All patients with ≥ 7 mm polyps reported on ultrasound scans at a hepatobiliary centre with eventual cholecystectomy over 20 years were retrospectively included. Four blinded radiologists reviewed selected images/clips. Shape and wall-thickening were used to categorize polyps. Imaging and relevant clinical features were used to derive guideline management into binary categories of no follow-up/follow vs refer-to-surgeon. Histological neoplastic polyps were defined as a positive outcome. Reliability, sensitivity, and specificity for both guidelines were tabulated.
One hundred thirty-five patients (mean age 51.9 years, 62 female [45.9%]) with a median polyp size of 12 mm (range 7-45) formed the study cohort. Twenty-eight out of one hundred thirty-five (20.7%) of patients had neoplastic polyps (1 low-grade dysplasia, 5 pyloric gland adenoma, 8 intracholecystic papillary neoplasm, 12 carcinoma in situ/carcinoma, 2 metastases). Pooled kappa values for SRUs and JES's polyp risk categorization were 0.70 (CI: 0.64-0.76) and 0.64 (CI: 0.57-0.71) for intra-observer and 0.41 (CI: 0.35-0.46) and 0.47 (CI: -0.40 to 0.53) for inter-observer agreement. SRU's low and indeterminate risk polyps had an odds ratio of 4.4 (p = 0.002) and 16.9 (p < 0.001) of being neoplastic compared to "very-low risk" polyps. Sensitivity, specificity and AUROC (CI) for SRU were 62% (43-80), 90% (85-95), 0.76 (0.66-0.86), and JES were 90% (79-100), 41% (32-49), 0.66 (0.58-0.73) respectively. The differences between the sensitivity and specificity of the two guidelines were significant (p = 0.002 and < 0.0001, respectively).
For ≥ 7 mm polyps, the SRU guidelines have significantly higher specificity with acceptable sensitivity, whereas the JES guidelines have significantly higher sensitivity with low specificity.
Question What are the diagnostic performances of the 2022 SRU and the JES guidelines for the management of ≥ 7 mm gallbladder polyps? Findings The SRU guidelines were significantly more specific but less sensitive than the JES guidelines. Clinical relevance For ≥ 7 mm polyps, the 2022 SRU guidelines would result in fewer surgical referrals and may be more applicable to the low-incidence populations of Europe and North America.
比较超声放射学会（SRU）和2022年欧洲联合学会（JES）胆囊息肉≥7mm诊治指南的诊断性能。
回顾性纳入一家肝胆中心20年间超声检查发现息肉≥7mm且最终接受胆囊切除术的所有患者。4名放射科医生对选定的图像/片段进行盲法评估。根据息肉形态和壁增厚情况进行分类。利用影像学和相关临床特征将指南管理措施分为无需随访/随访与转诊至外科医生两个类别。组织学诊断为肿瘤性息肉作为阳性结果。列出两种指南的可靠性、敏感性和特异性。
135例患者（平均年龄51.9岁，女性62例[45.9%]）纳入研究队列，息肉大小中位数为12mm（范围7 - 45mm）。135例患者中有28例（20.7%）为肿瘤性息肉（1例低级别异型增生、5例幽门腺腺瘤、8例胆囊内乳头状肿瘤、12例原位癌/癌、2例转移瘤）。SRU和JES息肉风险分类的观察者内一致性组内相关系数分别为0.70（95%CI：0.64 - 0.76）和0.64（95%CI：0.57 - 0.71），观察者间一致性组内相关系数分别为0.41（95%CI：0.35 - 0.46）和0.47（95%CI：0.40 - 0.53）。与 “极低风险” 息肉相比，SRU的低风险和不确定风险息肉发生肿瘤的比值比分别为4.4（P = 0.
