A 3-pronged ultrasound (US) based scoring system can aid in differentiating between cholesterol polyps and adenomatous polyps in the gallbladder, according to a study published in the Journal of Clinical Gastroenterology.

Investigators reviewed the US and cholecystectomy pathology results of patients who had gallbladder polyps with maximum size of 1.0 to 1.5 cm. US images of cholesterol polyps vs adenomatous polyps were compared. Based on these results, investigators developed a scoring system to differentiate polyp type. The scoring system was then evaluated in a validation cohort. 

In total, 107 polyps were found: 80 were cholesterol polyps and 27 were adenomatous. Patients were aged 40.77±11.56 years; 55 patients were women.


Continue Reading

Of the 14 different criteria that researchers analyzed, height-width ratio, vascularity, and the presence of a hyperechoic spot were all statistically significant between cholesterol and adenomatous polyps.

Researchers developed a scoring system based on these 3 factors, in which a total score of ≥5 was predictive for an adenomatous polyp.

Table 1. Ultrasound Scoring System to Differentiate Polyp Type

Height-width ratio<0.9=4≥0.9=0
VascularityPresent=3Absent=0
Hyperechoic spotAbsent=2Present=0

An additional 56 patients served as the validation cohort. The US scoring system had a sensitivity of 73.33%, specificity of 80.49%, and accuracy of 78.57% during validation.

The study was limited by its small sample size and retrospective nature. Additional validation via a large, multi-centered, prospective trial would be beneficial.

Despite any limitations, the US scoring system may aid to further define current polyp size-based guidelines and prevent unnecessary cholecystectomies.

Reference

Zhu L, Han P, Jiang B, et al. Value of conventional ultrasound-based scoring system in distinguishing adenomatous polyps from cholesterol polyps. J. Clin. Gastroenterol. Published online December 15, 2021. doi: 10.1097/MCG.0000000000001639