ABSTRACT
BACKGROUND. The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations for small gallbladder polyps support management that is less aggressive than earlier approaches and may help standardize evaluation of polyps by radiologists. OBJECTIVE. The purpose of the present study was to assess the interreader agreement of radiologists in applying SRU recommendations for management of incidental gallbladder polyps on ultrasound. METHODS. This retrospective study included 105 patients (75 women and 30 men; median age, 51 years) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003, and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using the SRU recommendations, assessed one polyp per patient to assign risk category (extremely low risk, low risk, or indeterminate risk) and make a possible recommendation for surgical consultation. Five radiologists were considered less experienced (< 5 years of experience), and five were considered more experienced (≥ 5 years of experience). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic. RESULTS. For risk category assignments, interreader agreement was substantial among all readers (k = 0.710), less-experienced readers (k = 0.705), and more-experienced readers (k = 0.692). For surgical consultation recommendations, inter-reader agreement was substantial among all readers (k = 0.795) and more-experienced readers (k = 0.740) and was almost perfect among less-experienced readers (k = 0.811). Of 10 readers, a median of 5.0 (IQR, 2.0-8.0), 4.0 (IQR, 2.0-7.0), and 0.0 (IQR, 0.0-0.0) readers classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the percentage of polyps classified as extremely low risk ranged from 32% to 72%; as low risk, from 24% to 65%; and as indeterminate risk, from 0% to 8%. Of 10 readers, a median of zero change to 0 (IQR, 0.0-1.0) readers recommended surgical consultation; the percentage of polyps receiving a recommendation for surgical consultation ranged from 4% to 22%. Of a total of 105 polyps, 102 were nonneo-plastic and three were neoplastic (all benign). Based on readers' most common assessments for nonneoplastic polyps, the risk category was extremely low risk for 53 polyps, low risk for 48 polyps, and indeterminate risk for one polyp; surgical consultation was recommended for 16 polyps. CONCLUSION. Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified. CLINICAL IMPACT. The findings support the overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.
Subject(s)
Incidental Findings , Polyps , Ultrasonography , Humans , Female , Male , Middle Aged , Polyps/diagnostic imaging , Polyps/surgery , Retrospective Studies , Ultrasonography/methods , Adult , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/surgery , Aged , Observer Variation , Radiologists , Societies, Medical , Consensus , Practice Guidelines as TopicABSTRACT
BACKGROUND: The prevalence of neoplastic polyps in gallbladder polyps (GPs) increases sharply with age and is associated with gallbladder carcinoma (GBC). This study aims to predict neoplastic polyps and provide appropriate treatment strategies based on preoperative ultrasound features in patients with different age level. METHODS: According to the age classification of WHO, 1523 patients with GPs who underwent cholecystectomy from January 2015 to December 2019 at 11 tertiary hospitals in China were divided into young adults group (n=622), middle-aged group (n=665) and elderly group (n=236). Linear scoring models were established based on independent risk variables screened by the Logistic regression model in different age groups. The area under ROC (AUC) to evaluate the predictive ability of linear scoring models, long- and short- diameter of GPs. RESULTS: Independent risk factors for neoplastic polyps included the number of polyps, polyp size (long diameter), and fundus in the young adults and elderly groups, while the number of polyps, polyp size (long diameter), and polyp size (short diameter) in the middle-aged groups. In different age groups, the AUCs of its linear scoring model were higher than the AUCs of the long- and short- diameter of GPs for differentiating neoplastic and non-neoplastic polyps (all P<0.05), and Hosmer-Lemeshow goodness of fit test showed that the prediction accuracy of the linear scoring models was higher than the long- and short- diameter of GPs (all P>0.05). CONCLUSION: The linear scoring models of the young adults, middle-aged and elderly groups can effectively distinguish neoplastic polyps from non-neoplastic polyps based on preoperative ultrasound features.
Subject(s)
Gallbladder Neoplasms , Polyps , Ultrasonography , Humans , Middle Aged , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/pathology , Female , Male , Retrospective Studies , Adult , Polyps/diagnostic imaging , Polyps/pathology , Age Factors , Aged , Risk Factors , Cholecystectomy , China/epidemiology , Preoperative Period , Young Adult , Preoperative CareABSTRACT
BACKGROUND: Gastric hamartomatous inverted polyps (GHIPs) are not well characterized and remain diagnostically challenging due to rarity. Therefore, this study aims to investigate the clinicopathologic and endoscopic characteristics of patients with GHIP. METHODS: We retrospectively reviewed clinicopathologic and endoscopic features of ten patients with GHIP who were admitted to Beijing Friendship Hospital from March 2013 to July 2022. All patients were treated successfully by endoscopic resection. RESULTS: GHIPs were usually asymptomatic and found incidentally during gastroscopic examination. They may be sessile or pedunculated, with diffuse or local surface redness or erosion. On endoscopic ultrasonography, the sessile submucosal tumor-type GHIP demonstrated a heterogeneous lesion with cystic areas in the third layer of the gastric wall. Histologically, GHIPs were characterized by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands accompanied by a branching proliferation of smooth muscle bundles. Inflammatory cells infiltration was observed in the stroma, whereas only one patient was complicated with glandular low-grade dysplasia. Assessment of the surrounding mucosa demonstrated that six patients (60%) had atrophic gastritis or Helicobacter pylori-associated gastritis, and four patients (40%) had non-specific gastritis. Endoscopic resection was safe and effective. CONCLUSIONS: GHIPs often arise from the background of abnormal mucosa, such as atrophic or H.pylori-associated gastritis. We make the hypothesis that acquired inflammation might lead to the development of GHIPs. We recommend to make a full assessment of the background mucosa and H. pylori infection status for evaluation of underlying gastric mucosal abnormalities, which may be the preneoplastic condition of the stomach.
Subject(s)
Adenomatous Polyps , Endosonography , Gastric Mucosa , Gastroscopy , Hamartoma , Polyps , Stomach Neoplasms , Humans , Male , Female , Middle Aged , Retrospective Studies , Hamartoma/pathology , Hamartoma/diagnostic imaging , Hamartoma/surgery , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Stomach Neoplasms/diagnostic imaging , Gastric Mucosa/pathology , Gastric Mucosa/diagnostic imaging , Gastric Mucosa/surgery , Adult , Aged , Polyps/pathology , Polyps/surgery , Polyps/diagnostic imaging , Stomach Diseases/pathology , Stomach Diseases/surgery , Stomach Diseases/diagnostic imaging , Helicobacter Infections/complications , Helicobacter Infections/pathology , Helicobacter pylori/isolation & purification , Gastritis/pathology , Gastritis/complications , Gastritis/diagnostic imaging , Gastritis, Atrophic/pathology , Gastritis, Atrophic/complications , Endoscopic Mucosal ResectionABSTRACT
OBJECTIVES: To assess the ability of the International Endometrial Tumor Analysis (IETA)-1 polynomial regression model to estimate the risk of endometrial cancer (EC) and other intracavitary uterine pathology in women without abnormal uterine bleeding. METHODS: This was a retrospective study, in which we validated the IETA-1 model on the IETA-3 study cohort (n = 1745). The IETA-3 study is a prospective observational multicenter study. It includes women without vaginal bleeding who underwent a standardized transvaginal ultrasound examination in one of seven ultrasound centers between January 2011 and December 2018. The ultrasonography was performed either as part of a routine gynecological examination, during follow-up of non-endometrial pathology, in the work-up before fertility treatment or before treatment for uterine prolapse or ovarian pathology. Ultrasonographic findings were described using IETA terminology and were compared with histology, or with results of clinical and ultrasound follow-up of at least 1 year if endometrial sampling was not performed. The IETA-1 model, which was created using data from patients with abnormal uterine bleeding, predicts four histological outcomes: (1) EC or endometrial intraepithelial neoplasia (EIN); (2) endometrial polyp or intracavitary myoma; (3) proliferative or secretory endometrium, endometritis, or endometrial hyperplasia without atypia; and (4) endometrial atrophy. The predictors in the model are age, body mass index and seven ultrasound variables (visibility of the endometrium, endometrial thickness, color score, cysts in the endometrium, non-uniform echogenicity of the endometrium, presence of a bright edge, presence of a single dominant vessel). We analyzed the discriminative ability of the model (area under the receiver-operating-characteristics curve (AUC); polytomous discrimination index (PDI)) and evaluated calibration of its risk estimates (observed/expected ratio). RESULTS: The median age of the women in the IETA-3 cohort was 51 (range, 20-85) years and 51% (887/1745) of the women were postmenopausal. Histology showed EC or EIN in 29 (2%) women, endometrial polyps or intracavitary myomas in 1094 (63%), proliferative or secretory endometrium, endometritis, or hyperplasia without atypia in 144 (8%) and endometrial atrophy in 265 (15%) women. The endometrial sample had insufficient material in five (0.3%) cases. In 208 (12%) women who did not undergo endometrial sampling but were followed up for at least 1 year without clinical or ultrasound signs of endometrial malignancy, the outcome was classified as benign. The IETA-1 model had an AUC of 0.81 (95% CI, 0.73-0.89, n = 1745) for discrimination between malignant (EC or EIN) and benign endometrium, and the observed/expected ratio for EC or EIN was 0.51 (95% CI, 0.32-0.82). The model was able to categorize the four histological outcomes with considerable accuracy: the PDI of the model was 0.68 (95% CI, 0.62-0.73) (n = 1532). The IETA-1 model discriminated very well between endometrial atrophy and all other intracavitary uterine conditions, with an AUC of 0.96 (95% CI, 0.95-0.98). Including only patients in whom the endometrium was measurable (n = 1689), the model's AUC was 0.83 (95% CI, 0.75-0.91), compared with 0.62 (95% CI, 0.52-0.73) when using endometrial thickness alone to predict malignancy (difference in AUC, 0.21; 95% CI, 0.08-0.32). In postmenopausal women with measurable endometrial thickness (n = 848), the IETA-1 model gave an AUC of 0.81 (95% CI, 0.71-0.91), while endometrial thickness alone gave an AUC of 0.70 (95% CI, 0.60-0.81) (difference in AUC, 0.11; 95% CI, 0.01-0.20). CONCLUSION: The IETA-1 model discriminates well between benign and malignant conditions in the uterine cavity in patients without abnormal bleeding, but it overestimates the risk of malignancy. It also discriminates well between the four histological outcome categories. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Subject(s)
Endometrial Hyperplasia , Endometrial Neoplasms , Endometritis , Polyps , Uterine Neoplasms , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Male , Endometritis/pathology , Retrospective Studies , Endometrial Neoplasms/diagnostic imaging , Endometrial Neoplasms/pathology , Endometrium/diagnostic imaging , Endometrium/pathology , Uterine Neoplasms/diagnostic imaging , Uterine Neoplasms/pathology , Uterine Hemorrhage/diagnostic imaging , Uterine Hemorrhage/pathology , Ultrasonography , Endometrial Hyperplasia/diagnostic imaging , Endometrial Hyperplasia/pathology , Polyps/diagnostic imaging , Polyps/pathology , Atrophy/pathologyABSTRACT
BACKGROUND: Computed tomography (CT) radiomics combined with deep transfer learning was used to identify cholesterol and adenomatous gallbladder polyps that have not been well evaluated before surgery. PURPOSE: To investigate the potential of various machine learning models, incorporating radiomics and deep transfer learning, in predicting the nature of cholesterol and adenomatous gallbladder polyps. MATERIAL AND METHODS: A retrospective analysis was conducted on clinical and imaging data from 100 patients with cholesterol or adenomatous polyps confirmed by surgery and pathology at our hospital between September 2015 and February 2023. Preoperative contrast-enhanced CT radiomics combined with deep learning features were utilized, and t-tests and least absolute shrinkage and selection operator (LASSO) cross-validation were employed for feature selection. Subsequently, 11 machine learning algorithms were utilized to construct prediction models, and the area under the ROC curve (AUC), accuracy, and F1 measure were used to assess model performance, which was validated in a validation group. RESULTS: The Logistic algorithm demonstrated the most effective prediction in identifying polyp properties based on 10 radiomics combined with deep learning features, achieving the highest AUC (0.85 in the validation group, 95% confidence interval = 0.68-1.0). In addition, the accuracy (0.83 in the validation group) and F1 measure (0.76 in the validation group) also indicated strong performance. CONCLUSION: The machine learning radiomics combined with deep learning model based on enhanced CT proves valuable in predicting the characteristics of cholesterol and adenomatous gallbladder polyps. This approach provides a more reliable basis for preoperative diagnosis and treatment of these conditions.
Subject(s)
Deep Learning , Tomography, X-Ray Computed , Humans , Female , Male , Retrospective Studies , Middle Aged , Tomography, X-Ray Computed/methods , Aged , Gallbladder/diagnostic imaging , Gallbladder Neoplasms/diagnostic imaging , Adult , Polyps/diagnostic imaging , Cholesterol , Gallbladder Diseases/diagnostic imaging , Predictive Value of Tests , Adenomatous Polyps/diagnostic imaging , Machine Learning , Contrast Media , RadiomicsABSTRACT
PURPOSE: To develop and validate a deep learning model for distinguishing healthy vocal folds (HVF) and vocal fold polyps (VFP) on laryngoscopy videos, while demonstrating the ability of a previously developed informative frame classifier in facilitating deep learning development. METHODS: Following retrospective extraction of image frames from 52 HVF and 77 unilateral VFP videos, two researchers manually labeled each frame as informative or uninformative. A previously developed informative frame classifier was used to extract informative frames from the same video set. Both sets of videos were independently divided into training (60%), validation (20%), and test (20%) by patient. Machine-labeled frames were independently verified by two researchers to assess the precision of the informative frame classifier. Two models, pre-trained on ResNet18, were trained to classify frames as containing HVF or VFP. The accuracy of the polyp classifier trained on machine-labeled frames was compared to that of the classifier trained on human-labeled frames. The performance was measured by accuracy and area under the receiver operating characteristic curve (AUROC). RESULTS: When evaluated on a hold-out test set, the polyp classifier trained on machine-labeled frames achieved an accuracy of 85% and AUROC of 0.84, whereas the classifier trained on human-labeled frames achieved an accuracy of 69% and AUROC of 0.66. CONCLUSION: An accurate deep learning classifier for vocal fold polyp identification was developed and validated with the assistance of a peer-reviewed informative frame classifier for dataset assembly. The classifier trained on machine-labeled frames demonstrates improved performance compared to the classifier trained on human-labeled frames.
Subject(s)
Deep Learning , Polyps , Humans , Laryngoscopy/methods , Vocal Cords/diagnostic imaging , Neural Networks, Computer , Retrospective Studies , Machine Learning , Polyps/diagnostic imagingABSTRACT
This article presents a comprehensive review of factors that increase the risk of malignancy in ultrasound findings of an endometrial polyp. We collected original studies, reviews, and meta-analyses that dealt with the topic of endometrial polyps and the risk of developing endometrial cancer. Each presumed risk factor was analysed individually. According to searched studies, abnormal uterine bleeding, old age, and body mass index are valid risk factors for developing endometrial cancer in endometrial polyps. Lynch syndrome patients are also in a high-risk group for endometrial cancer. On the other hand, the number of polyps, their size, diabetes mellitus, hypertension, and positive family history are factors with inconclusive results. There are either not enough data or different results among several studies.
Subject(s)
Endometrial Neoplasms , Polyps , Uterine Diseases , Uterine Neoplasms , Female , Humans , Pregnancy , Uterine Neoplasms/pathology , Endometrial Neoplasms/diagnostic imaging , Endometrial Neoplasms/etiology , Uterine Diseases/complications , Polyps/diagnostic imaging , Polyps/pathology , Risk Factors , Hysteroscopy , Uterine Hemorrhage/etiology , Endometrium/pathologyABSTRACT
BACKGROUND: It is important to identify gallbladder polyps (GPs) with malignant potential and avoid unnecessary cholecystectomy by constructing prediction model. The aim of the study is to develop a Bayesian network (BN) prediction model for GPs with malignant potential in a long diameter of 8-15 mm based on preoperative ultrasound. METHODS: The independent risk factors for GPs with malignant potential were screened by χ2 test and Logistic regression model. Prediction model was established and validated using data from 1296 patients with GPs who underwent cholecystectomy from January 2015 to December 2019 at 11 tertiary hospitals in China. A BN model was established based on the independent risk variables. RESULTS: Independent risk factors for GPs with malignant potential included age, number of polyps, polyp size (long diameter), polyp size (short diameter), and fundus. The BN prediction model identified relationships between polyp size (long diameter) and three other variables [polyp size (short diameter), fundus and number of polyps]. Each variable was assigned scores under different status and the probabilities of GPs with malignant potential were classified as [0-0.2), [0.2-0.5), [0.5-0.8) and [0.8-1] according to the total points of [- 337, - 234], [- 197, - 145], [- 123, - 108], and [- 62,500], respectively. The AUC was 77.38% and 75.13%, and the model accuracy was 75.58% and 80.47% for the BN model in the training set and testing set, respectively. CONCLUSION: A BN prediction model was accurate and practical for predicting GPs with malignant potential patients in a long diameter of 8-15 mm undergoing cholecystectomy based on preoperative ultrasound.
Subject(s)
Gallbladder Diseases , Gallbladder Neoplasms , Polyps , Humans , Gallbladder/surgery , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/pathology , Bayes Theorem , Gallbladder Diseases/surgery , Cholecystectomy , Ultrasonography , Polyps/diagnostic imaging , Polyps/surgery , Polyps/pathology , Retrospective StudiesABSTRACT
BACKGROUND: Polyp size of 10 mm is insufficient to discriminate neoplastic and non-neoplastic risk in patients with gallbladder polyps (GPs). The aim of the study is to develop a Bayesian network (BN) prediction model to identify neoplastic polyps and create more precise criteria for surgical indications in patients with GPs lager than 10 mm based on preoperative ultrasound features. METHODS: A BN prediction model was established and validated based on the independent risk variables using data from 759 patients with GPs who underwent cholecystectomy from January 2015 to August 2022 at 11 tertiary hospitals in China. The area under receiver operating characteristic curves (AUCs) were used to evaluate the predictive ability of the BN model and current guidelines, and Delong test was used to compare the AUCs. RESULTS: The mean values of polyp cross-sectional area (CSA), long, and short diameter of neoplastic polyps were higher than those of non-neoplastic polyps (P < 0.0001). Independent neoplastic risk factors for GPs included single polyp, polyp CSA ≥ 85 mm 2, fundus with broad base, and medium echogenicity. The accuracy of the BN model established based on the above independent variables was 81.88% and 82.35% in the training and testing sets, respectively. Delong test also showed that the AUCs of the BN model was better than that of JSHBPS, ESGAR, US-reported, and CCBS in training and testing sets, respectively (P < 0.05). CONCLUSION: A Bayesian network model was accurate and practical for predicting neoplastic risk in patients with gallbladder polyps larger than 10 mm based on preoperative ultrasound features.
Subject(s)
Gallbladder Diseases , Gallbladder Neoplasms , Polyps , Humans , Gallbladder/surgery , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/pathology , Bayes Theorem , Gallbladder Diseases/surgery , Ultrasonography , Polyps/diagnostic imaging , Polyps/surgery , Polyps/pathology , Retrospective StudiesABSTRACT
BACKGROUND: Placental polyps are rare complications of delivery or abortion. They are thought to complicate less than 0.25% of all pregnancies, although the actual incidence is unknown. While they typically occur within four weeks of delivery or abortion, they can have a variable presentation, which can lead to a delay in care. CASE PRESENTATION: A 35-year-old G4P2012 patient presented at 9 weeks gestation for a medication abortion. Post-abortion ultrasound after one week confirmed the abortion was complete and her bleeding ceased. The patient then presented two months later with the new onset of worrisome bleeding. She was found on ultrasound to have a new hypervascular polypoidal mass in the endometrial cavity. She then underwent an in-office dilation and curettage with an electric vacuum aspirator, which was curative. A follow up ultrasound three months later demonstrated no recurrence. CONCLUSIONS: Placental polyps are a rare complication following pregnancy and should be included in the differential when a patient presents with bleeding and a new mass in the endometrial cavity on ultrasound following a delivery or abortion, even when frankly retained products of conception had been ruled out at time of abortion.
Subject(s)
Abortion, Induced , Abortion, Spontaneous , Polyps , Puerperal Disorders , Pregnancy , Female , Humans , Adult , Placenta , Uterus , Abortion, Induced/adverse effects , Polyps/complications , Polyps/diagnostic imagingABSTRACT
PURPOSE: To verify whether radiomics techniques based on dual-modality ultrasound consisting of B-mode and superb microvascular imaging (SMI) can improve the accuracy of the differentiation between gallbladder neoplastic polyps and cholesterol polyps. METHODS: A total of 100 patients with 100 pathologically proven gallbladder polypoid lesions were enrolled in this retrospective study. Radiomics features on B-mode ultrasound and SMI of each lesion were extracted. Support vector machine was used to classify adenomas and cholesterol polyps of gallbladder for B-mode, SMI and dual-modality ultrasound, respectively, and the classification results were compared among the three groups. RESULTS: Six, eight and nine features were extracted for each lesion at B-mode ultrasound, SMI and dual-modality ultrasound, respectively. In dual-modality ultrasound model, the area under the receiver operating characteristic curve (AUC), classification accuracy, sensitivity, specificity, and Youden's index were 0.850 ± 0.090, 0.828 ± 0.097, 0.892 ± 0.144, 0.803 ± 0.149 and 0.695 ± 0.157, respectively. The AUC and Youden's index of the dual-modality model were higher than those of the B-mode model (p < 0.05). The AUC, accuracy, specificity and Youden's index of the dual-modality model were higher than those of the SMI model (p < 0.05). CONCLUSIONS: Radiomics analysis of the dual-modality ultrasound composed of B-mode and SMI can improve the accuracy of classification between gallbladder neoplastic polyps and cholesterol polyps.
Subject(s)
Gallbladder , Polyps , Humans , Pilot Projects , Gallbladder/diagnostic imaging , Gallbladder/pathology , Diagnosis, Differential , Retrospective Studies , Ultrasonography/methods , Polyps/diagnostic imaging , Polyps/pathology , CholesterolABSTRACT
BACKGROUND: The study aimed to explore the value of CT findings and inflammatory indicators in differentiating benign and malignant gallbladder polypoid lesions before surgery. METHODS: The study comprised a total of 113 pathologically confirmed gallbladder polypoid lesions with a maximum diameter ≥ 1 cm (68 benign and 45 malignant), all of which were enhanced CT-scanned within 1 month before surgery. The CT findings and inflammatory indicators of the patients were analyzed by univariate and multivariate logistic regression analysis to identify independent predictors of gallbladder polypoid lesions, and then a nomogram distinguishing benign and malignant gallbladder polypoid lesions was developed by combining these characteristics. The receiver operating characteristic (ROC) curve and decision curve were plotted to assess the performance of the nomogram. RESULTS: Base status of the lesion (p < 0.001), plain CT value (p < 0.001), neutrophil-lymphocyte ratio (NLR) (p = 0.041), and monocyte-lymphocyte ratio (MLR) (p = 0.022) were independent predictors of malignant polypoid lesions of the gallbladder. The nomogram model established by incorporating the above factors had good performance in differentiating and predicting benign and malignant gallbladder polypoid lesions (AUC = 0.964), with sensitivity and specificity of 82.4% and 97.8%, respectively. The DCA demonstrated the important clinical utility of our nomogram. CONCLUSION: CT findings combined with inflammatory indicators can effectively differentiate benign and malignant gallbladder polypoid lesions before surgery, which is valuable for clinical decision-making.
Subject(s)
Gallbladder Neoplasms , Polyps , Humans , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/pathology , Polyps/diagnostic imaging , Polyps/surgery , Sensitivity and Specificity , Tomography, X-Ray Computed , Retrospective StudiesABSTRACT
PURPOSE: To evaluate whether different measurements of endometrial thickness pre-IVF cycle and during the IVF cycles as measured by transvaginal ultrasound are associated with the absence or presence of endometrial polyps. DESIGN: A retrospective cohort study was conducted in a university-affiliated fertility center. Patients were women who underwent two embryo transfer cycles and failed to conceive. INTERVENTIONS: hysteroscopic evaluation and resection of any masses. RESULTS: There was no difference on comparing the groups with and without polyps in the mean endometrial thicknesses at baseline scans pre-treatment or during IVF cycle. For women who failed two embryo transfer cycles, at any given endometrial thickness the probability of the presence of a polyp was 30-40%. ROC curves failed to detect an actionable relationship with different endometrial thicknesses and the relationship with an endometrial polyp, with most areas under the curve being just above 0.5. However, once the maximum stimulated endometrial thickness was ≥ 13 mm, there was a 70% chance of a polyp being noted at hysteroscopy. This was a statistical difference in the probability of a polyp being present as compared to the lesser thicknesses (p = 0.05). CONCLUSION: Baseline or maximum stimulated endometrial thickness at IVF fails to predict with accuracy the presence of a polyp. However, if the maximum stimulated thickness was at least 13 mm, there was a higher probability of a uterine polyp being present. Such a cutoff would nevertheless miss most polyps. At any baseline thickness on CD 2-5, a polyp has a 30-40% probability of being present in women who failed two embryo transfers. ROC curves suggest that at baseline, or maximum stimulated endometrial thickness, the ability to predict a polyp is no better than flipping a coin. As such, endometrial cavity evaluation for polyps is legitimate in women with two embryo transfers irrelevant of the baseline or stimulated thickness.
Subject(s)
Polyps , Uterine Neoplasms , Pregnancy , Humans , Female , Male , Retrospective Studies , Uterine Neoplasms/pathology , Endometrium/diagnostic imaging , Endometrium/pathology , Hysteroscopy , Embryo Transfer , Polyps/diagnostic imaging , Polyps/surgery , Polyps/complications , Fertilization in VitroABSTRACT
Intracholecystic papillary neoplasia (IPN) is a rare entity rarely described in the literature, of incidental anatomopathological diagnosis in a cholecystectomy specimen that presents a premalignant behavior, with progression to carcinoma in more than 50% of cases. In the absence of an invasive component, clinical follow-up is recommended, without associating another surgical gesture, with a 5-year prognosis (90% survival). We present a case of a patient with an incidental diagnosis of NPIC after laparoscopic cholecystectomy due to presenting a gallbladder polyp.
Subject(s)
Cholecystectomy, Laparoscopic , Gallbladder Diseases , Gallbladder Neoplasms , Gastrointestinal Neoplasms , Polyps , Humans , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Diagnosis, Differential , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/surgery , Polyps/diagnostic imaging , Polyps/surgery , Gastrointestinal Neoplasms/surgeryABSTRACT
Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.
Subject(s)
Gallbladder Diseases , Gallbladder Neoplasms , Gastrointestinal Neoplasms , Polyps , Humans , Gallbladder Diseases/diagnostic imaging , Polyps/diagnostic imaging , Polyps/pathology , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/pathology , RadiologistsABSTRACT
MAIN RECOMMENDATIONS: 1. Primary investigation of polypoid lesions of the gallbladder should be with abdominal ultrasound. Routine use of other imaging modalities is not recommended presently, but further research is needed. In centres with appropriate expertise and resources, alternative imaging modalities (such as contrast-enhanced and endoscopic ultrasound) may be useful to aid decision-making in difficult cases. Strong recommendation, low-moderate quality evidence. 2. Cholecystectomy is recommended in patients with polypoid lesions of the gallbladder measuring 10 mm or more, providing the patient is fit for, and accepts, surgery. Multidisciplinary discussion may be employed to assess perceived individual risk of malignancy. Strong recommendation, low-quality evidence. 3. Cholecystectomy is suggested for patients with a polypoid lesion and symptoms potentially attributable to the gallbladder if no alternative cause for the patient's symptoms is demonstrated and the patient is fit for, and accepts, surgery. The patient should be counselled regarding the benefit of cholecystectomy versus the risk of persistent symptoms. Strong recommendation, low-quality evidence. 4. If the patient has a 6-9 mm polypoid lesion of the gallbladder and one or more risk factors for malignancy, cholecystectomy is recommended if the patient is fit for, and accepts, surgery. These risk factors are as follows: age more than 60 years, history of primary sclerosing cholangitis (PSC), Asian ethnicity, sessile polypoid lesion (including focal gallbladder wall thickening > 4 mm). Strong recommendation, low-moderate quality evidence. 5. If the patient has either no risk factors for malignancy and a gallbladder polypoid lesion of 6-9 mm, or risk factors for malignancy and a gallbladder polypoid lesion 5 mm or less, follow-up ultrasound of the gallbladder is recommended at 6 months, 1 year and 2 years. Follow-up should be discontinued after 2 years in the absence of growth. Moderate strength recommendation, moderate-quality evidence. 6. If the patient has no risk factors for malignancy, and a gallbladder polypoid lesion of 5 mm or less, follow-up is not required. Strong recommendation, moderate-quality evidence. 7. If during follow-up the gallbladder polypoid lesion grows to 10 mm, then cholecystectomy is advised. If the polypoid lesion grows by 2 mm or more within the 2-year follow-up period, then the current size of the polypoid lesion should be considered along with patient risk factors. Multidisciplinary discussion may be employed to decide whether continuation of monitoring, or cholecystectomy, is necessary. Moderate strength recommendation, moderate-quality evidence. 8. If during follow-up the gallbladder polypoid lesion disappears, then monitoring can be discontinued. Strong recommendation, moderate-quality evidence. SOURCE AND SCOPE: These guidelines are an update of the 2017 recommendations developed between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery-European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). A targeted literature search was performed to discover recent evidence concerning the management and follow-up of gallbladder polyps. The changes within these updated guidelines were formulated after consideration of the latest evidence by a group of international experts. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. KEY POINT: ⢠These recommendations update the 2017 European guidelines regarding the management and follow-up of gallbladder polyps.
Subject(s)
Gallbladder Neoplasms , Gastrointestinal Neoplasms , Polyps , Endoscopy, Gastrointestinal , Follow-Up Studies , Gallbladder , Gallbladder Neoplasms/diagnosis , Humans , Middle Aged , Polyps/diagnostic imaging , Polyps/surgeryABSTRACT
BACKGROUND AND AIM: Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm. We assessed the value of ultrasound scoring system based on independent predictive parameters in distinguishing adenomatous polyps from cholesterol polyps with the maximum size of 1.0 to 1.5 cm. MATERIALS AND METHODS: We enrolled 163 patients with gallbladder polyps (1.0 to 1.5 cm) who underwent ultrasonography and cholecystectomy. Ultrasound image characteristics were compared between cholesterol polyps and adenomatous polyps in the training cohort from April 2018 to January 2020. An ultrasound scoring system was constructed in the training cohort, and its diagnostic performance was evaluated in the validation cohort from February 2020 to February 2021. RESULTS: Maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot were significantly different between cholesterol polyps and adenomatous polyps in the training cohort ( P <0.05). The independent predictive parameters for adenomatous polyps were lower height/width ratio, presence of vascularity and absence of hyperechoic spot. The total score was as follows: (height/width ratio, <0.9=4, ≥0.9=0) + (vascularity, present=3, absent=0) + (hyperechoic spot, absent=2, present=0). The sensitivity, specificity and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33%, 80.49%, and 78.57%, respectively. CONCLUSIONS: The ultrasound scoring system aids in distinguishing adenomatous polyps from cholesterol polyps, and effectively decreasing unnecessary cholecystectomy.
Subject(s)
Adenomatous Polyps , Gallbladder Diseases , Gallbladder Neoplasms , Polyps , Adenomatous Polyps/diagnostic imaging , Cholesterol , Diagnosis, Differential , Humans , Polyps/diagnostic imaging , Retrospective Studies , Sewage , Ultrasonography/methodsABSTRACT
BACKGROUND. Previous European multisociety guidelines recommend routine follow-up imaging of gallbladder polyps (including polyps < 6 mm in patients without risk factors) and cholecystectomy for polyp size changes of 2 mm or more. OBJECTIVE. The purpose of this study was to assess longitudinal changes in the number and size of gallbladder polyps on serial ultrasound examinations. METHODS. This retrospective study included patients who underwent at least one ultrasound examination between January 1, 2010, and December 31, 2020 (as part of a hepatocellular carcinoma screening and surveillance program) that showed a gallbladder polyp. Number of polyps and size of largest polyp were recorded based primarily on review of examination reports. Longitudinal changes on serial examinations were summarized. Pathologic findings from cholecystectomy were reviewed. RESULTS. Among 9683 patients, 759 (8%) had at least one ultrasound examination showing a polyp. Of these, 434 patients (248 men, 186 women; mean age, 50.6 years) had multiple examinations (range, 2-19 examinations; mean, 4.8 examinations per patient; mean interval between first and last examinations, 3.6 ± 3.1 [SD] years; maximum interval, 11.0 years). Among these 434 patients, 257 had one polyp, 40 had two polyps, and 137 had more than two polyps. Polyp size was 6 mm or less in 368 patients, 7-9 mm in 52 patients, and 10 mm or more in 14 patients. Number of polyps increased in 9% of patients, decreased in 14%, both increased and decreased on serial examinations in 22%, and showed no change in 55%. Polyp size increased in 10% of patients, decreased in 16%, both increased and decreased on serial examinations in 18%, and showed no change in 56%. In 9% of patients, gallbladder polyps were not detected on follow-up imaging; in 6% of patients, gallbladder polyps were not detected on a follow-up examination but were then detected on later studies. No gallbladder carcinoma was identified in 19 patients who underwent cholecystectomy. CONCLUSION. Gallbladder polyps fluctuate in size, number, and visibility over serial examinations. Using a 2-mm threshold for growth, 10% increased in size. No carcinoma was identified. CLINICAL IMPACT. European multisociety guidelines that propose surveillance of essentially all polyps and a 2-mm size change as the basis for cholecystectomy are likely too conservative for clinical application.
Subject(s)
Gallbladder Diseases/diagnostic imaging , Incidental Findings , Polyps/diagnostic imaging , Ultrasonography/methods , Female , Gallbladder/diagnostic imaging , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
The natural history of intracholecystic papillary neoplasm (ICPN), especially the speed of growth from small benign to a carcinomatous lesion, is quite unrevealed. Here, we report an extremely rare case of ICPN, in which the papillary lesion was observed transforming from small and benign to malignant using abdominal ultrasound (AUS) over 2 years during routine health checks. A 44-year-old man underwent a routine health check-up. The initial AUS showed a small sessile polyp in the gallbladder, which enlarged slightly at the next AUS, a year later. In the third year, the polypoid lesion enlarged markedly, with a maximum diameter of 10 × 9 × 7 mm. Therefore, a laparoscopic cholecystectomy was performed. Microscopically, the 10 mm tumor had intracytoplasmic mucus, and a clear cytoplasm compatible with gastric-type features. Immunohistochemical analysis showed positive staining of atypical cells for MUC6 and PAS. These findings led to the diagnosis of ICPN with high-grade intraepithelial neoplasia of the gastric type. In conclusion, sessile polyps with rapid growth might be a crucial finding in the early stage of ICPN.
Subject(s)
Gallbladder Neoplasms , Polyps , Adult , Gallbladder Neoplasms/diagnosis , Humans , Male , Polyps/diagnostic imaging , Polyps/pathology , UltrasonographyABSTRACT
OBJECTIVES: The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. METHODS: This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. RESULTS: In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. CONCLUSIONS: We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.