Accuracy of Ultrasound in Diagnosing Gallbladder Polyps at a Community Hospital.
Accuracy of Ultrasound in Diagnosing Gallbladder Polyps at a Community Hospital.
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DOI：
10.4293/jsls.2020.00052
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
Kleiner D
中科院分区：
文献类型：
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作者：
Ostapenko A;Liechty S;Kim M;Kleiner D
在胆囊常规经腹超声检查中，有1-10%的病例报告有息肉。先前的研究报道了这种诊断方式在确定息肉恶性潜能方面的敏感性和特异性较差。本研究的目的是确定在社区医院超声记录的胆囊息肉的发生率，评估超声与最终组织病理学的一致性，并探讨可能提高超声诊断真正腺瘤性息肉准确性的因素。我们对2014年至2019年在丹伯里医院接受胆囊切除术的患者进行了一项为期5年的回顾性队列研究，确定了术前超声提到“息肉”或“肿块”的患者。我们评估了超声检查结果与病理报告的一致性。在进行的2，549例胆囊切除术中，1，944例（76%）进行了术前超声检查。其中，98例（5.0%）报告了息肉，平均测量值为8.1 mm（SD 7.1 mm）。3份（3.1%）标本在最终组织病理学检查中被确定为腺瘤;大多数为良性病理，包括胆固醇息肉（18）、胆固醇沉着症（20）、腺肌瘤（4）、腺肌瘤病（7）和慢性或急性胆囊炎（44）。有趣的是，3个腺瘤中只有1个在超声上测量> 10 mm，这是手术切除的公认适应症。经腹超声诊断真正息肉的准确性很差，只有3%的息肉根据病理学确定为腺瘤。外科医生在根据超声识别的息肉做出临床决策时应谨慎，需要更严格的诊断标准，以降低诊断和筛查的假阳性率。
Polyps are reported on 1–10% of routine transabdominal ultrasound studies of the gallbladder. Prior studies have reported poor sensitivity and specificity for this diagnostic modality at determining malignant potential of polyps. The aim of this study is to determine the incidence of gallbladder polyps documented on ultrasound at a community hospital, evaluate the congruency of ultrasound with final histopathology, and explore factors which may improve ultrasound accuracy at diagnosing true adenomatous polyps. We conducted a 5-year retrospective cohort study of patients undergoing cholecystectomy at Danbury Hospital between 2014 and 2019, identifying those with a pre-operative ultrasound mention of a “polyp” or “mass.” We assessed the congruency of ultrasound findings with pathology reports. Of the 2,549 cholecystectomies performed, 1,944 (76%) had pre-operative ultrasounds. Of those, 98 (5.0%) reported a polyp, measuring an average of 8.1 mm (SD 7.1 mm). Three (3.1%) specimens were identified as adenomas on final histopathology; the majority were benign pathologies including cholesterol polyp (18), cholesterolosis (20), adenomyoma (4), adenomyomatosis (7), and chronic or acute cholecystitis (44). Interestingly, only 1 of the 3 adenomas measured > 10 mm on ultrasound, the accepted indication for surgical resection. The accuracy of transabdominal ultrasound in diagnosing true polyps is poor, with only 3% of polyps identified as adenomas based on pathology. Surgeons should use caution when making clinical decisions based on polyps identified on ultrasound, and more stringent diagnostic criteria are needed in order to decrease the false positive rate for diagnosis and screening.