benign vs malignant features of gallbladder polyps
In most instances predicting benign versus malignant histology of a gallbladder polyp based purely on imaging features is not possible. However, a number of features are helpful in helping to decide the management of a gallbladder polyp.
Benign features
- size
- polyps that are less than 5 mm in size are almost always cholesterol polyps
- 5-10 mm polyps may warrant follow-up to ensure no interval growth
- morphology
- pedunculated
- number
- >50% of cholesterol polyps are multiple
- growth
- stable size
- CT/MRI enhancement
- similar to the rest of the gallbladder wall
- US features
- small echogenic focus or cluster of foci
- comet tail artifact (cholesterol polyp)
Malignant features
- size
- >10 mm: ~62.5% (range 37-88%) are malignant
- morphology
- sessile
- number
- solitary lesion
- growth
- interval increase in size
- CT/MRI enhancement
- greater than the normal gallbladder wall
One should always take the pretest probability of disease into account as well. For instance, patients with a history of primary sclerosing cholangitis (PSC) have a higher likelihood of developing cholangiocarcinoma and a gallbladder polyp in these patients is a malignancy until proven otherwise.
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