AJR F and L Medical Products: Radiation Protection & More
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tublin, M. E.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Tublin, M. E.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?
AJR 2001; 177:467
© American Roentgen Ray Society

Answer

Mitchell E. Tublin

Albany Medical College Albany, NY 12208

Any reservations about the potential of sonography to screen for gallbladder carcinoma are certainly justified, particularly given the present health care climate. Polypoid lesions of the gallbladder are a frequent incidental finding at sonography, with prevalence rates reported in the literature as ranging from 4-7% [1, 2]. Most of these lesions are benign cholesterol polyps. Although gallbladder carcinoma may present as a polypoid lesion, this occurrence, fortunately, is exceedingly rare, at least in the United States.

The theoretic rationale for the sonographic follow-up of patients with gallbladder polyps is based on a polyp-to-cancer sequence—similar to that seen in colon carcinomas—in which an adenomatous polyp progresses to a frank gallbladder carcinoma [3]. This sequence is by no means universally accepted, however. Others have suggested that gallbladder carcinomas arise in situ from flat, dysplastic epithelium [4]. Even if one accepts the polyp-to-carcinoma sequence, distinguishing between a benign cholesterol polyp and a potentially premalignant adenoma on the basis of sonographic features is impossible (although multiplicity and increased echogenicity may be indicative of the benign cholesterol polyp).

Size, though, is a useful discriminating feature between benign and malignant polyps: most polypoid gallbladder carcinomas found in patients participating in large-scale cholecystectomy series have been larger than 1 cm [5]. This observation has resulted in the current practice of 6-month or yearly follow-ups of patients with gallbladder polyps smaller than 1 cm. The results of a recent prospective series by Collet et al. [2] together with the anecdotal experience of many sonographers and the epidemiology of gallbladder polyps may make routine polyp surveillance unsupportable. None of the follow-up sonograms performed on 33 and 22 of 38 subjects with gallbladder polyps at 2 and 5 years, respectively, showed any change suggestive of malignant transformation.

Despite these findings, old habits take a long time to break, and when it comes to a disease as dismal as gallbladder carcinoma, it is hard to resist a potential hedge. I currently recommend follow-up sonograms at 6- to 12-month intervals for polyps larger than 5 mm in patients without other potentially life-threatening illnesses. I probably will continue to make this recommendation until appropriately designed large-scale trials and cost-analysis studies say I can do otherwise.

References

  1. Jorgensen T, Jensen K. Polyps in the gallbladder: a prevalence study. Scand J Gastroenterol 1990;25:281[Medline]
  2. Collett J, Allan R, Chisholm R, Wison I, Burt M, Chapman B. Gallbladder polyps: prospective study. J Ultrasound Med 1998;17:207 -211[Abstract]
  3. Aldridge MC, Bismuth H. Gallbladder cancer: the polyp-cancer sequence. Br J Surg 1990;77:363 -364[Medline]
  4. Albores-Saavedra J, Vardaman CJ, Vuitch F. Non-neoplastic polypoid lesions and adenomas of the gallbladder. Pathol Annu 1993;28:145 -147
  5. Yang HL, Sun YG, Wang Z. Polypoid lesions of the gallbladder: diagnosis and indications for surgery. Br J Surg 1992;79:227 -229[Medline]

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tublin, M. E.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Tublin, M. E.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS