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Gray-scale and color examples of high-strain elastographic patterns that are entirely green on the elastogram: a) 40-year-old woman with gallbladder polyp (arrow) identified as benign on follow-up sonography; b) a 43-year-old man with a gallbladder polyp (long arrow) identified as benign on follow-up sonography. Small arrows denote a three-layered artifact pattern.
Source publication
Gallbladder polyps often have a benign nature. Current guidelines suggest surgical removal of polyps greater than 10 mm. However, the accuracy of the size criteria is limited because neoplasia can be found in gallbladder polyps less than 10 mm. The aim of this study was to evaluate the feasibility of real time elastography for gallbladder polyps an...
Context in source publication
Context 1
... elastographic gallbladder polyp images obtained from the 53 patients were interpretable for as- sessing the elastographic pattern. All benign gallbladder polyps on consecutive real-time elastographic images ap- peared as having a greater than average or average elasto- graphic pattern. Elastographic images showed most gall- bladder polyps as a mosaic of green, yellow and red (28 out of 52, 53.8%), whereas the remaining polyps showed either entirely green (12 out of 52, 23.1%) or red with partially yellow areas (12 out of 52, 23.1%) (fig 1-4). The histopathologic subtype was found to be cholesterol polyps in 9 cases and hyperplastic polyps in 3 cases that underwent cholecystectomy in 12 patients. Elastographic images of all hyperplastic polyps and 5 of the cholesterol polyps were a mosaic of green, yellow and red, 2 of the cholesterol polyps were entirely green and 2 of the cho- lesterol polyps were red with partially yellow ...
Citations
... US-E could be an additional tool to distinguish malignancies from benign condition of gallbladder wall. Using SE, gallbladder polyps were characterized by medium-high strain (soft or moderately soft) compared to only one single small nodule (measuring 19 mm) defined as gallbladder carcinoma which exhibited low strain (high stiffness) [83]. Considering differential diagnosis between benign wall thickening and gallbladder carcinoma, Kapoor et al., reported that the p-SWE values could distinguish between the two conditions with 92.8% accuracy [84]. ...
Ultrasound imaging is the first-line investigation for patients with abdominal symptoms, as it effectively depicts the gastrointestinal tract and enables the diagnosis of multiple pathological conditions. Among different recent ultrasound technological advancements, elastography enables the evaluation of various tissue characteristics, such as neoplastic transformation or fibroinflammatory status. In recent years, ultrasound elastography has been utilized extensively for the study of liver diseases and in numerous other clinical settings, including gastrointestinal diseases. Current guidelines suggest the use of transabdominal ultrasound elastography to characterize bowel wall lesions, to assess gastrointestinal contractility, to diagnose and grade chronic pancreatitis; however, no specific indications are provided. In the present paper, we summarize the evidence concerning the application of different ultrasound elastography modalities in gastrointestinal non-liver diseases.
... Their findings confirm that all benign polyps have lower propagation velocities in comparison with the malignant ones. Their study showed that point shear-wave elastography (pSWE) of gall bladder lesions is feasible and can be useful for the differential diagnosis of GB neoplasm [27]. ...
Background
Gall bladder carcinoma (GBC) is the most common biliary epithelial neoplasm. Its slow progression and late presentation lend it a poor prognosis. The risk factors can be divided into cholelithiasis, inflammatory causes, infection, exposure, and gall bladder pathologies. It usually spreads by hematogenous or lymphatic route or directly invades the liver. There are many controversies related to guidelines for management of gall bladder polyps and treatment options.
Main text
This review article attempts to give definitive guidelines for the same and helps the reader distinguish it from other benign mimickers. The emerging role of newer modalities like contrast ultrasound, elastography, and magnetic resonance cholangiopancreatography has also been briefly mentioned. This paper reviews the literature to provide concise background, etiopathogenesis, radiological findings, and management options of GBC.
Conclusions
Out of all the available modalities MDCT, FDG-PET CT, and image-guided biopsies play the most important role in diagnosis and follow-up. Imaging remains elementary in pre-operative planning and management of gall bladder neoplasms.
... It has been reported that the contrast arrival time and the time to peak enhancement are significantly longer in patients with GB carcinoma compared to benign adenomas [63]. Role of ultrasound elastography in diagnosing malignant GB polyps is unclear but preliminary studies suggest that it may have utility [64,65]. Similarly, recent studies show that texture analysis and deep-learningbased decision support system for the diagnosis of neoplastic GB polyps on ultrasonography may have a promising role in the future [66,67]. ...
Gallbladder (GB) carcinoma is a relatively rare malignancy and is associated with poor prognosis. Numerous risk factors have been associated with the development of GB carcinoma. GB carcinomas may present as mass lesions replacing the GB, focal or diffuse thickening of the GB wall, and intraluminal mass in the GB. Various benign conditions can mimic GB carcinoma. This article reviews the epidemiology, pathology, clinical findings, imaging features, and management of GB carcinomas. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.
... Inflammation, adenomyomatosis, skinfolds and cholecystolithiasis may be misinter pr eted as polyps dur ing ultr asonogr aphy. To limit false positive outcomes, new scan methods have been suggested, such as elastogr aphy and use of contr ast-enhanced ultr asound [4,5]. Fur ther mor e, ultr asonogr aphy of gallbladder polyps has been shown to be r epr oducible [6]. ...
Introduction:
Gallbladder polyps often have a benign appearance by ultrasonography. Even so, the current guideline recommends follow-up in gallbladder polyps lesser-than 6 mm. The aim of this study was to investigate long-term follow-up growth of polyps in patients with a polyp size lesser-than 6 mm in a ten-year cohort.
Methods:
Abdominal ultrasonography reports from 2007 to 2009 were reviewed, including reports on patients diagnosed with a gallbladder polyp (polyp size lesser-than 6 mm) during the 2007-2009 period. The patients were invited to a final follow-up ultrasonography of the gallbladder conducted during October 2019 to February 2020. A total of 154 patients were included (100 women and 54 men).
Results:
In 53 patients (34.4%), the polyp was not visible at the ultrasonography follow-up. Gallbladder polyps were confirmed in 101 (65.6%) patients. A total of 49 patients had a single polyp (31.8%) and 52 (33.8%) patients had multiple polyps. The median size of the gallbladder polyp was 4 mm (range: 2.0-5.9 mm) at baseline compared with 4 mm (range: 1.7-15.0 mm) at the follow-up. A total of 15 patients experienced polyp growth of 2 mm or more. None developed gallbladder cancer.
Conclusions:
Our study showed that gallbladder polyps lesser-than 6 mm has a low probability of increasing in size. None of the patients with small polyps developed gallbladder cancer.
Funding:
none.
Trial registration:
not relevant.
... There are studies that suggest elastography can help in differentiating malignant and benign. 48,49 With this method, inflammatory tissue can be differentiated from the masses of epithelial tissue. Teber et al. evaluated the feasibility of elastography in a preliminary report. ...
... They reported that the benign lesions have a high-strain elastographic pattern and malign lesions had low elasticity properties. 49 Kapoor et al. reported that the likelihood of malignancy is high with a mean shear wave velocity of 2.7 m/s or greater with elastography (sensitivity 100%, specificity 91%). 48 Magnetic resonance elastography may be another alternative diagnostic tool for validation of the size and location of lesions. ...
Introduction:
Gallbladder polyps (GBPs) are generally harmless, but the planning of diagnosis and treatment of the GBP is of clinical importance due to the high mortality risk of delays in the diagnosis of gallbladder carcinomas that show polypoid development.
Materials and methods:
GBPs are usually incidentally detected during ultrasonographic (USG) examinations of the abdomen. The risk of carcinoma development from polypoid lesions in the literature is reported as 0-27%. There is no consensus about the management of the GBPs. Herein, we reviewed the contemporary data to update our knowledge about diagnosis and treatment of gallbladder polyps.
Results:
Polyps can be identified in five different groups, primarily as neoplastic and non-neoplastic. Cholesterol polyps account for 60% of all cases. The most common (25%) benign polypoid lesions after cholesterol polyps are adenomyomas.
Conclusion:
Ultrasonography and endoscopic ultrasonography seems to be the most important tool in differential diagnosis and treatment. Ultrasonography should be repeated in every 3-12 months in cases that are thought to be risky. Nowadays, the most common treatment approach is to perform cholecystectomy in patients with polyps larger than 10 mm in diameter. Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy.
How to cite this article:
Dilek ON, Karsu S, et al. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol 2019;9(1):40-48.
... Sonoelastography is a new, non-invasive US method used for evaluation of the elastic properties of tissues based on static compression and cross-correlation methods, qualitatively and/or quantitatively. The main elasto-graphic techniques include strain elastography (SE), in which the tissues are compressed axially, and shear wave elastography (SWE), which uses waves that are generated by transducers and interact with the tissue [9][10][11][12][13]. Elastography has been successfully applied to lesions of the breast, prostate, pancreas, lymph nodes, thyroid gland, testes, and liver [9][10][11][12][13]. ...
... The main elasto-graphic techniques include strain elastography (SE), in which the tissues are compressed axially, and shear wave elastography (SWE), which uses waves that are generated by transducers and interact with the tissue [9][10][11][12][13]. Elastography has been successfully applied to lesions of the breast, prostate, pancreas, lymph nodes, thyroid gland, testes, and liver [9][10][11][12][13]. Nevertheless, it is not yet routinely used in clinical practice in the diagnosis of tendinopathy. ...
Aim:
To investigate strain (SE) and shear wave elastography (SWE) characteristics of the long head of the biceps tendon (LHBT) tendinosis in comparison with magnetic resonance imaging (MRI) findings.
Material and methods:
Twenty patients with a MRI diagnosis of tendinosis and twenty healthy subjects with normal LHBT in MRI were prospectively examined by SE and SWE. SE color mapping was divided into four types in accordance with elasticity designs: type I predominantly blue (hardest tissue), type II predominantly blue-green (hard tissue), type III predominantly green (intermediate tissue), type IV predominantly green-yellow-red (soft tissue). Quantitative measurements of LHBT hardness with SWE were analyzed in kilopascals (kPa).
Results:
In the tendinosis group SE types in transverse scan were I in 24% of tendons, II in 50%, III in 25%, and in longitudinal scan I in 15%, II in 75%, and III in 10%. In the control group SE types in transversescan were II in 10% of tendons, III in 55%, IV in 35%, and in longitudinal scan II in 10%, III in 55%, and IV in 35%. SWE values in transverse scan were 38.32±7.2 kPa in the tendinosis group and 18.6±3.1 kPa in the control groupand in longitudinal scan 39.42±7.4 kPa in the tendinosis group, and 20.62±4.6 in the control group. There was a statistically significant difference in terms of elasticity patterns between the tendinosis and control groups (p<0.001). The receiver operating characteristic curve analysis was perfect and a cut-off value of tranverse 25.8 kPa and longitudinal, 24.6 kPa shear values had very high sensitivity and specificity for tendinosis.
Conclusion:
SE and SWE may be useful diagnostic tools for LHBT tendinosis when considering usability, cost effectiveness, and patient preference compared to MRI.
... Several studies on novel US techniques have been conducted to overcome the shortcomings of conventional US imaging. Teber et al. (24) evaluated the feasibility of using real-time US elastography for GB polyps, and found that benign GB polyps had a high-strain elastographic pattern. In the studies using real-time contrast-enhanced (CE) EUS, GB adenomas showed homogeneous enhancement patterns, in contrast to cholesterol polyps which show heterogeneous enhancement patterns (1). ...
Objective
To investigate the feasibility of ex vivo multispectral photoacoustic (PA) imaging in differentiating cholesterol versus neoplastic polyps, and benign versus malignant polyps, of the gallbladder.
Materials and Methods
A total of 38 surgically confirmed gallbladder polyps (24 cholesterol polyps, 4 adenomas, and 10 adenocarcinomas) from 38 patients were prospectively included in this study. The surgical specimens were set on a gel pad immersed in a saline-filled container. The PA intensities of polyps were then measured, using two separate wavelength intervals (421–647 nm and 692–917 nm). Mann-Whitney U test was performed for the comparison of normalized PA intensities between the cholesterol and neoplastic polyps, and between the benign and malignant polyps. Kruskal-Wallis test was conducted for the comparison of normalized PA intensities among the cholesterol polyps, adenomas, and adenocarcinomas.
Results
A significant difference was observed in the normalized PA intensities between the cholesterol and neoplastic polyps at 459 nm (median, 1.00 vs. 0.73; p = 0.032). Comparing the benign and malignant polyps, there were significant differences in the normalized PA intensities at 765 nm (median, 0.67 vs. 0.78; p = 0.013), 787 nm (median, 0.65 vs. 0.77; p = 0.034), and 853 nm (median, 0.59 vs. 0.85; p = 0.028). The comparison of the normalized PA intensities among cholesterol polyps, adenomas, and adenocarcinomas demonstrated marginally significant differences at 765 nm (median, 0.67 vs. 0.66 vs. 0.78, respectively; p = 0.049).
Conclusion
These preliminary results indicate that benign versus malignant gallbladder polyps might exhibit different spectral patterns on multispectral PA imaging.
... In some studies, it has been reported that there is a connection between the tissue elasticity and histological features. Elastography is used successfully in prostate, lymph node, breast, thyroid, testis, renal and liver disease examination [12][13][14][15][16]. However, to the best of our knowledge, there has been no work in the previous literature that has investigated the optic nerve with elastography in MS patients. ...
Aims:
Our aim was to evaluate the elasticity features of the optic nerve using strain (SE) and shear wave elastography (SWE) in multiple sclerosis (MS) patients in comparison with healthy subjects.
Material and methods:
One hundred and seven optic nerves from 54 MS patients and 118 optic nerves from 59 healthy subjects were examined prospectively by SE and SWE. Optic nerves were divided into three types in accordance to the elasticity designs, as follows: type 1 predominantly blue (hardest tissue); type 2 predominantly blue/green (hard tissue); and type 3 predominantly green (intermediate tissue). Quantitative measurements of optic nerve hardness with SWE were analyzed in kilopascals.
Results:
Elastographic images from healthy volunteers showed mostly type 3 optic nerves (61.9%); type 2 was also found (38.1%), but type 1 was not observed. Elastographic examination of MS patients showed mostly type 2 optic nerves (88%), while some type 1 (4.6%) and type 3 optic nerves (6.5%) were rarely observed. There was a statistically significant difference in terms of elasticity patterns between patients and healthy volunteers (p<0.001). Statistically significant differences were observed between patients and healthy volunteers in the analysis of SWE values (10.381±3.48 kPa and 33.87±11.64 p<0.001). The receiver operating characteristic curve analysis was perfect (0.993; 95% confidence interval [CI]=0.971-0.999), and a cut-off value of 18.3 kPa shear had very high sensitivity and specificity for the patient group. No significant differences were observed between patients with and without previous optic neuritis.
Conclusion:
SE and SWE examination findings concerning the optic nerve in MS patients demonstrated remarkable differences according to the healthy group.
Objective:
To study the utility of 2D shear wave elastography (SWE) and ascertain cut-off values of shear wave elasticity (SWe) to differentiate benign and malignant thickening of the gallbladder wall.
Methods:
This study was a prospective study of patients with symptomatic gallstone disease (GSD, n = 51) and gallbladder cancer (GBC, n = 46) and controls without any biliary disease (n = 46). All the participants underwent 2D USG and SWE of the gallbladder. Grey-scale ultrasound and SWE were done in the different regions in the gallbladder.
Results:
The median age of the patients with GSD was 49 years (interquartile range [IQR]: 33-55), GBC was 55 years (IQR: 46-65), and controls was 37 years (IQR: 27-48.25). In patients with GBC, asymmetrical mural thickening was the predominant imaging pattern (n = 24, 52.2%). The mean SWe of the abnormal area in GBC (34.99 ± 17.77 kPa [n = 46]) was significantly higher than that of the uninvolved region (18.27 ± 8.12 kPa [n = 35]; P < .01). The mean SWe of the uninvolved region in GBC (18.27 ± 8.12 kPa [n = 35]) was also significantly higher (P < .01) than that of GSD (12.27 ± 4.13 kPa [n = 51]) and controls (10.52 ± 3.75 kPa [n = 46]). On ROC analysis, AUC of 0.927, at a cut-off of 20 kPa, sensitivity was 91.3%, specificity was 83.5%, positive likelihood ratio was 5.54, and negative likelihood ratio was 0.10 to diagnose GBC.
Conclusion:
The 2D SWE is a reliable adjunctive tool to grey-scale USG in differentiating the malignant from benign gallbladder wall and may help to pick up early malignancy in GSD.
The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings with a series of position papers to give advice on characterization and management. The biliary system (gallbladder and biliary tree) is the third most frequent site for incidental findings. This first part of the position paper on incidental findings of the biliary system is related to general aspects, gallbladder polyps and other incidental findings of the gallbladder wall. Available evidence on prevalence, diagnostic work-up, malignancy risk, follow-up and treatment is summarized with a special focus on ultrasound techniques. Multiparametric ultrasound features of gallbladder polyps and other incidentally detected gallbladder wall pathologies are described, and their inclusion in assessment of malignancy risk and decision- making on further management is suggested.
