[1673] Is 1 cm a Valid Cut-Off as the Cholecystectomy Indication for Gallbladder Polyps?: Clinicopathologic Analysis of 432 Cases

Nevra Dursun, Pelin Bagci, Burcu Saka, Olca Basturk, Courtney Vance, Juan C Roa, Oscar Tapia, Hector Losada, Juan Sarmiento, Kee-Taek Jang, Takuma Tajiri, Engin Cigerciogullari, So Yeon Kong, Michael Goodman, Volkan Adsay. Emory University, Atlanta, GA; Memorial Sloan-Kettering Cancer Center, New York, NY; Pontificia University, Santiago, Chile

Background: Polyps of the GB are common incidental lesions. 1 cm is the arbitrary criteria widely employed as the indication for cholecystectomy. The value of this cut-off has not been systematically verified from histopathology perspective.
Design: Clinicopathologic characteristics of 432 polypoid lesions >3mm were analyzed.
Results: See Tables 1&2. (NNP: non-neoplastic polyp; ICPN: intracholecystic papillary neoplasm; i.e., WHO's “adenomas” and “intracystic papillary neoplasms”;FMG: Fibromyoglandular/fibroepithelial polyp;CP: Cholesterol polyp)

Table 1
Tumor Characteristics†Polypoid Invasion (n = 29)ICPN (n = 120)Incipient ICPN (n = 41)Cholesterol-like polyp (n = 148)Dysplasia in otherwise NNP (n = 18)FMG (n = 76)p-value‡
Age (±SD)70.7 (8.6)61.0 (14.3)59.9 (11.7)49.7 (11.8)58.6 (10.5)55.6 (15.3)<0.001
Gender
Female24 (85.7%)79 (67.5%)29 (85.3%)93 (65.0%)11 (64.7%)60 (81.1%)0.019
Male4 (14.3%)38 (32.5%)5 (14.7%)50 (35.0%)6 (35.3%)14 (18.9%)
Average Size, cm (range)2.8 (0.9 - 6.0)2.6 (1.0 - 7.7)0.45 (0.3 - 0.9)0.52 (0.3 - 2)1.1 (0.3 - 5.0)0.47 (0.3 - 1.3)<0.0001
<1cm4 (13.8%)041 (100%)139 (93.9%)9 (50.0%)72 (94.7%)<0.0001
≥1cm25 (86.2%)120 (100%)09 (6.1%)9 (50.0%)4 (5.3%)
Inflammation degree
Score 002 (1.8%)03 (2.1%)00<0.0001
Score 14 (28.6%)39 (33.9%)18 (56.3%)109 (75.7%)10 (62.5%)30 (43.5%)
Score 24 (28.6%)48 (41.7%)11 (34.4%)25 (17.3%)5 (31.3%)25 (36.2%)
Score 36 (42.8%)26 (22.6%)3 (9.3%)7 (4.9%)1 (6.2%)14 (20.3%)




Table 2
Polyp SizeNeoplastic GB Polyps† (n = 208)Non-neoplastic GB Polyps‡ (n = 224)p-value*
<1cm (n (%))54 (26.0%)211 (94.2%)<0.0001
≥1cm (n(%))154 (74.0%)13 (5.8%)
†Neoplastic GB Polyps = Polypoid invasion + ICPNs of all types+ Dysplasia in otherwise NNP. ‡Non-neoplastic GB Polyps = Cholesterol-like polyp + FMG + Others. ∗Based on Fisher's chi square test.


Conclusions: GB polyps >2cm are virtually all neoplastic. 1 cm is a reasonable but less reliable cut-off for cholecystectomy indication: While only 6% of the more common non-neoplastic polyps are >1 cm, at the same time, about a quarter of the neoplastic polyps are <1 cm. Other paramaters elucidated in this study that may help in the management algorithm in favor of holding off a cholecystectomy include absence of severe background inflammation (which may be helpful in the radiologic differential diagnosis), younger age, and male gender, which are in favor of a cholesterol-polyp.
Category: Liver

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 200, Tuesday Morning

 

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