Differential diagnosis of benign and malignant gallbladder polypoid lesions with maximum diameter ≥1 cm based on CT radiomics / 中国医学影像技术

Objective: To explore the value of radiomics based on CT in differential diagnosis of benign and malignant polypoid lesions of the gallbladder (PLG). Methods: Totally 145 patients with PLG ≥1 cm who underwent abdominal enhanced CT examination and confirmed by pathology were collected. Among them, benign PLG was found in 82 cases, while malignant ones were detected in 63 cases. The patients were randomly divided into training set and test set. 3D ROIs of portal vein phase CT images were manually segmented using ITK-SNAP software. AK software was introduced to extract high-dimensional radiomics features. Then Lasso regression was used to reduce the dimension of the features. Logistic regression model was established and tested with R language software. Finally, the diagnostic performance of the model was evaluated with ROC. Results: Seven features related to benign and malignant identification of gallbladder polyps were obtained. The optimal threshold based on training set was 0.370. After the model was established, the threshold was used for test set with accuracy was 0.886, the specificity and sensitivity was 0.880 and 0.895, respectively, and AUC was 0.924. Conclusion: CT radiomics can effectively identify benign and malignant PLG with the maximum diameter ≥1 cm.

Prevalence and Risk Factors of Gallbladder Polypoid Lesions in a Healthy Population

PURPOSE: To determine the prevalence of and investigate the risk factors for gallbladder (GB) polypoid lesions in a healthy population. MATERIALS AND METHODS: A total of 23827 subjects who underwent abdominal ultrasonography in conjunction with health screening examinations were retrospectively analyzed. The prevalence of risk factors for GB polypoid lesions were evaluated. In addition, risk factors according to the number of polypoid lesions and the presence of stones with polypoid lesions were investigated. To analyze these risk factors, a control group was established with a 1:2 ratio matched for age and sex. RESULTS: The prevalence of GB polypoid lesions was identified as 9.96%. On multivariate analysis, chronic hepatitis B infection (CHB) and the presence of metabolic syndrome (MS) were risk factors for GB polypoid lesions. CHB and MS were also significant independent risk factors for multiple GB polypoid lesions when compared with solitary GB polypoid lesions. In addition, gastric Helicobacter pylori infection and MS were significant risk factors for GB polypoid lesions with stones when compared with GB polypoid lesions without stones. CONCLUSION: The prevalence of GB polypoid lesions in a healthy Korean population was 9.96%. Patients with CHB and MS need to be carefully examined for such lesions.

Analysis of gallbladder polypoid lesion size as an indication of the risk of gallbladder cancer

BACKGROUNDS/AIMS: Recent advances in ultrasonography have contributed to the early detection of gallbladder cancer. We attempted to predict the progression of the disease by comparing the sizes of polypoid lesions, and we suggest that the size of the lesion would be a useful guideline to determine an appropriate primary surgical approach for polypoid lesions of the gallbladder. METHODS: We have retrospectively analyzed 253 patients that, during the operation period from January 2009 to December 2011, had had ultrasonographically detected gallbladder polypoid lesions, and who underwent cholecystectomy at Ulsan university hospital. We have analyzed the demographic data of the patients, the preoperative size of polypoid lesions, and pathologic findings. RESULTS: Of a total of 253 patients, 235 patients had benign lesions, and 18 patients had malignant lesions. Among the malignant polyp patients, 11 had pT1 cancer, 6 had pT2 cancer, and 1 had pT3 cancer. The average size of polypoid lesions was 9.1+/-3.1 mm and that of malignant lesions was 28.2+/-16.4 mm. The receiver operating characteristic (ROC) curve of the benign and malignant groups shows that 14.5 mm is the optimal point of prediction of the malignancy. Of a total of 18 patients of GB cancer, 11 had pT1 and the average size of their polypoid lesions was 20.5+/-5.8 mm 7 had pT2 with a size of 39.1+/-20.7 mm. ROC curve analysis of the pT1 and pT2 groups shows that 27 mm would be the optimal point to predict T2 and above cancer. CONCLUSIONS: In the case of an early cancer, curative treatment can be achieved through a simple and minimally invasive laparoscopic cholecystectomy. We attempted to predict early cancer occurrence among polypoid lesions of the gallbladder using the simplest standard, size. Although there are some limitations, size can be a simple and easy way to evaluate polypoid lesions of the gallbladder.

Therapeutic Plan for Benign Polypoid Lesion of Gallbladder

PURPOSE: Since the laparoscopic cholecystectomy became an usual procedure, operative indications of the gallbladder polyps have had the tendency to enlarge. There are no precise management plan about the gallbladder polyps which is not included in the accepted operative indications. Therefore a management plan may be required for the patients who has gallbladder polyps which is not accepted operative indications. METHODS: We retrospectively analysed 106 patients with gallbladder polyps who were diagnosed preoperatively by ultrasound and CT from January 1991 to January 2005. Our operation indications are polyp above 10 mm, symptomatic polyp, sessile polyp, coincidence of stone, focal thickening of gallbladder wall, diffuse wall thickening and detection during other operations. The gallbladder polyps which were suspected to the gallbladder cancer strongly on radiologic studies and polyps above 20 mm size were excluded in this studies. RESULTS: Among the 106 patients, 87 patients underwent operation, and polypoid lesions disappeared during the follow-up period in 3 patients, and 16 patients are on regular follow up. Fifty-six cases received operation with accepted operative indications, and the thirty-one cases underwent operation by the patient's demand. Two groups showed significant difference in true polyp on pathological diagnosis (P < 0.001). There was 16.07% true polyp in opertive indication based 56 patients and no true polyp in patient's demanded 31 cases. The pathologic diagnoses were cholesterol polyp in 27 patients (87.15%), no polyp in 2 patients, adenomatous hyperplasia in 2 patients. The correlation of the polyp size and pathologic diagnosis was an inverse relation to the polyp size and incidence of pseudopolyp (P=0.014). CONCLUSION: We propose that the 6-month-interval follow-up observation is fully safe for polyps sized below 10 mm and not included in accepted operative indications.

Polypoid Lesions of Gallbladder: Clinicopathological Features and Indication of Operation

PURPOSE: Polypoid lesions of the gall bladder (PLG) have a variety of pathologies. Problems exist in the selection of patients for operation and in the operative approach used. We studied the accuracy of the preoperative radiologic diagnosis and suspected risk factors. METHODS: 121 polypoid lesions of gallbladder were sugically treated during 10 years. Preoperative radiologic diagnosis, age, gender, related symptoms, concurrent gallstone, size, shape, number and histologic diagnosis of the ployps were retrospectively reviewed. RESULTS: The average size of malignancy was 23.0 mm, and that of benign tumors was 7.1 mm (P=0.000). The mean age of patients with a malignancy was significant higher than that of those with benign tumor (P=0.000). The preoperative sensitivity of computed tomography for a malignancy was 67.7%. The patients with malignancy more frequently had related symptoms. CONCLUSION: A CT must be considered, for patients with risk factors, even if the ultrasonographic diagnosis was benign. An Age greater than 60 years, a tumor size greater than 10 mm, a solitary polyp, sessile shape, and related symptoms are predictive factors of a malignancy.

Surgical Guideline of Polypoid Lesions of Gallbladder / 한국간담췌외과학회지

BACKGRAOUND/AIMS: The biologic nature of polypoid lesions of gallbladder is difficult to define before surgical intervention and operative indication is still controversial. The aim of this study is to provide surgical guideline for polypoid lesions of gallbladder. METHODS: Clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions of gallbladder in 48 patients who had cholecystectomy from January 1992 to August 2002 in the Department of Surgery, Kang-nam General Hospital Public Corporation. RESULTS: There were 40 benign polypoid lesions including 30 cholesterol polyps, 5 adenomas, 4 inflammatory polyps and 1 adenomyomatous hyperplasia and 8 malignant polypoid lesions. Data analysis showed that neoplastic polypoid lesions of gallbladder correlated significantly with size and malignant polypoid lesions of gallbladder correlated significantly with size and age. CONCLUSION: The risk factor for neoplasm was the size of the polypoid lesions of gallblaldder (> or =10 mm) and the risk factors for malignancy were the size of the polypoid lesions of gallblaldder (> or =10 mm) and age (> or =50). Surgical intervention should be considered when a polypoid lesion of the gallbladder is larger than 10 mm and patient is older than 50 years.

Surgical Indications for Polypoid Lesions of the Gallbladder

PURPOSE: Polyps and polypoid lesions of the gallbladder are now increasingly detected. However the nature of disease is hard to define before operation and the indications for surgical intervention remain controversial. We attempted to differentiate between benign polyps and neoplastic lesions by comparing their clinical data and pathological findings. METHODS: The study comprised 128 consecutive patients who underwent resection for polypoid lesions of the gallbladder. The lesions were classified into five groups histologically, and the clinico-pathological characteristics were compared among the groups. RESULTS: We found cholesterol polyps in 42 patients, inflammatory polyps in 13, adenomyomatoses in 14, adenomas in 15, and carcinomas in 44. The mean age of the patients with carcinoma, all of whom were over 40 years, was significantly higher than that of the other groups (P<0.05). Carcinoma patients showed a female preponderance. The incidences of gallstones and presenting symptoms were not different between the benign and malignant diseases. The mean diameters of cholesterol polyps and inflammatory polyps were less than 5 mm, those of adenomyomatoses and adenomas were around 1 cm, and that of carcinoma was over 2 cm (P<0.05). Most of the benign polyps were pedunculated, but sessile lesions were more frequent in the malignant polyps (P<0.05). Neoplastic polyps tended to be single. CONCLUSION: It is suggested that polypoid lesions of the gallbladder should be removed surgically when the lesion exceeds 1 cm in diameter, is single in number, or is sessile. The possibility for malignancy should be considered if the patient is female, and over 40 years of age.

Operative Criteria for Polypoid Lesions of the Gallbladder

BACKGROUND: There is no definite criteria for treatment of polypoid lesions of the gallbladders although they may have malignant potentials. METHODS: Surgically resected polypoid lesions of the gallbladders of 68 patients who were treated at the Department of Surgery, Pusan National University Hospital, from Jan. 1986 to Dec. 1996 were evaluated based on the patients' sex and age, histologic results, and operative methods. RESULTS: The numbers of each type of polypoid lesion of the gallbladder were 28 cases (41.2%) of cholesterol polyps, 6 cases (8.8%) of inflammatory polyps, 8 cases (11.8%) of gallbladder adenomas, and 26 cases (38.2%) of gallbladder cancers. Two histologic characteristics of an adenoma and a carcinoma in situ coexisted in two cases of gallbladder cancers, in another two cases, there were adenomatous residue in their tissues, and in four cases of gallbladder adenomas, the authors could identify intestinal metaplasia in the tissues. Thus, the probablility of the adenoma-carcinoma sequence was suspected because of these results. The cancer risk of gallbladder polyps increased propotionally with their sizes and was related with their shapes. In the sessile group, the mean maximal diameter was 8.2+/-3.4 mm in benign polyps and 31.8+/-11.9 mm in malignant polyps (p<0.005). In the pedunculated group, the mean maximal diameter was 9.8+/-6.3 mm in benign polyps and 34.8+/-13.9 mm in malignant polyps (p<0.005). The sizes of the gallbladder cancers were evenly distributed in the sessile group but in the pedunculated group there was only one case with a maximal diameter of 13.8 mm, all others were over 20 mm. In the age and the sex distributions, benign polyps were distributed mainly below 50 in both genders, but malignant polyps were distributed above an age of 50 in men and were evenly distributed in women of all ages. CONCLUSIONS: The authors would recommend operations in case of the following: 1) age: above 50 in men, and all ages in women; and 2) size: above 10 mm the in pedunculated group, and above 5 mm in the sessile group.

Pathologic Classification and Evaluation of Gastric Benign Polypoid Lesions on Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: The detection rate of the gastric polyp tends to be increased according to development of endoscopic biopsy or polypectomy. However, some of the endoscopically polypoid lesions are not true polyps, and these lesions actually show non-specific finding. Therefore, it is necessary to classify gastric polypoid lesion on endoscopy. METHODS: For investigation of gastric benign polypoid lesions on endoscopy, we reviewed 544 gastric polypoid leisons and classified accordi.ng to Snover's criteria, from 1994 to 1996 of Soonchunhyang University Hospital. RESULT: 1. Among 544 gastric polypoid lesions, 440 cases(81%) of epithelial lesions, 78 cases(14%) of nonspecific polypoid lesions, and 26 cases(5%) of submucosal tumors and were noted. The epithelial lesions consisted of neoplastic polyps(21%), hyperplastic polyps(53%), and limited hyperplasia(26%). Nonspecific polypiod lesions consisted of 29 cases of hypertrophy of muscularis mucosa, 24 cases of lymphoid hyperplasia, 16 cases of edema of lamina propria, 7 cases of submucosal edema and fibrosis, and 2 cases of submucosal lymphangiectasia. Submucosal tumors consisted of 9 cases of stromal tumor, 8 cases of ectopic pancreas, 5 cases of inflammatory fibroid polyp, 2 cases of xanthoma, 1 case of lipoma, and 1 acse of lymphangioma. 2. The size over 0.5 cm in neoplastic polyp and hyperplastic polyp occupied 48.4%, and 32.2% respectively. And the size under 0.2 cm in limited hyperplasia occupied 72% of total cases. The distribution of Yamada type of polypoid leisons revealed type II predominancy in neoplastic polyps(46.2%), even distribution in hypeplastic polyps(I; 65, II; 77, III; 78 cases), and type I predominancy in limited hyperplasia(64.9%). The distribution of the localization of the polypoid lesion disclosed antrum predominancy in neoplastic polyps(50.5%) and hyperplastic polyps(38.6). CONCLUSIONS: Benign gastric polypoid leisons on endoscopy were not only neoplastic and hyperplastic polyps, but also limited regenerative hyperplasia of epithelium and submucosal nonspecific inflammation and fibrosis, which tended to be smaller in size than neoplastic and hyperplastic polyp and belonged to Yamada type I or II.

The clinical application of argon plasma coagulation(APC) for treating different alimentary lesions endo-scopically / 中华消化内镜杂志

Objective To retrospectively analyze the results of 52 cases with different diseases of alimentary tract treated by APC and evaluate its effectiveness and safety. Methods From April 2001 to May 2002, 52 cases with different digestive diseases were treated by APC under endoscopy , the disorders included 29 cases of GI bleeding (peptic ulcer 9, angiodysplasia 8, stoma bleeding 3, postpolypectomy bleeding 5 and flat crenated adenoma bleeding , duodenal angiodysplasia, multiple colon AVM and stoma bleeding of cardiac cancer, 1 in each) ,and 23 cases of polypoid lesion( esophagus and cardia polyps 5, flat esophageal lesion with dysplasia 1, Menetrier's disease 1, colon-rectal polyps 6, multiple polyps 5, and stump of giant sessile adenoma 4 and postoperative recurrence of cardia carcinoma 1). Results The theraputic results showed that only one GU case with artery spurting faild after APC therapy of bleeding ulcers, the hemostasis rate for all GI bleeding was 96. 5%. For the polyp smaller than 5mm in diameter, APC was the choice of treatment, but polypectomy with snare is suitable for bigger polyp or adenoma before APC for stump clearance, and the endocut (high-frequency e-lectron) was safe and effective for giant sessile adenomas, we had only one case with mucosa gas vacu-ole which had no clinical event. Conclusion APC has excellent effect of hemostasis on most non-porta-hypertensive GI bleeding except bigger artery spurting, and it combined with endocut is a safe and effective treatment of various polypoid lesions.