Which is the best imaging method to diagnose gallbladder carcinoma in patients with asymptomatic gallbladder polyps?

Management of gallbladder polyps

European Surgery ◽

10.1007/s10353-020-00659-8 ◽

2020 ◽

Author(s):

Dietmar Öfner

Keyword(s):

Cancer Detection ◽

Rare Event ◽

Imaging Method ◽

Additional Risk ◽

Gallbladder Polyps ◽

Gallbladder Mucosa ◽

Current Guidelines ◽

Relevant Level ◽

Gallbladder Malignancy

Summary A gallbladder polyp (GP) is defined as an elevation of the gallbladder mucosa that protrudes into the gallbladder lumen. Gallbladder polyps (GPs) have an estimated prevalence in adults of 0.3–12.3%. However, only 5% of polyps are considered “true” GPs that have malignant potential or are even already cancerous. The most important imaging method for diagnosis and follow-up of GPs is transabdominal ultrasound, but it fails to discriminate between true and pseudo polyps at a clinically relevant level. Although gallbladder cancer (GBC) arising from polyps is a rare event, malignancy is significantly more common among polyps from a size of 10 mm. In light of this, the consensus, which is reflected in current guidelines, is that surgery should be considered for polyps of 10 mm or greater. However, 10 mm is an arbitrary cutoff, and high-quality evidence to support this is lacking. Lowering the threshold for cholecystectomy when patients have additional risk factors for gallbladder malignancy may improve the cancer detection rate in polyps smaller than 10 mm. Nevertheless, the evidence behind this is also weak. This review shows the shortcomings in the available evidence and underlines the decision-making process regarding the surgical indication, surveillance, or both.

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Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population

Malaysian Journal of Medical Sciences ◽

10.21315/mjms2021.28.1.4 ◽

2021 ◽

Vol 28 (1) ◽

pp. 27-34

Author(s):

Abhishek Gautam ◽

Anshuman Pandey ◽

Shakeel Masood ◽

Smita Chauhan ◽

Dinesh Choudhary ◽

...

Keyword(s):

Gallbladder Carcinoma ◽

Tnm Staging ◽

Malignant Polyp ◽

Tertiary Referral Centre ◽

Gallbladder Polyps ◽

Northern India ◽

Cancer Group ◽

Endemic Population ◽

Benign Histology ◽

Malignant Lesions

Background: Gallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population. Methods: A retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used. Results: Of 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031). Conclusion: Cholecystectomy needs to be considered early in the management of small- sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.

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Gallbladder polyps ultrasound: what the sonographer needs to know

Journal of Ultrasound ◽

10.1007/s40477-021-00563-1 ◽

2021 ◽

Author(s):

G. Cocco ◽

R. Basilico ◽

A. Delli Pizzi ◽

N. Cocco ◽

A. Boccatonda ◽

...

Keyword(s):

Secondary Level ◽

Gallbladder Wall ◽

Imaging Method ◽

Abdominal Sonography ◽

Gallbladder Polyps ◽

First Choice ◽

Indispensable Tool ◽

Malignant Polyps ◽

Mesenchymal Tumours ◽

Acoustic Shadowing

AbstractGallbladder polyps are protuberances of the gallbladder wall projecting into the lumen. They are usually incidentally found during abdominal sonography or diagnosed on histopathology of a surgery specimen, with an estimated prevalence of up to 9.5% of patients. Gallbladder polyps are not mobile and do not demonstrate posterior acoustic shadowing; they may be sessile or pedunculated. Gallbladder polyps may be divided into pseudopolyps and true polyps. Pseudopolyps are benign and include cholesterolosis, cholesterinic polyps, inflammatory polyps, and localised adenomyomatosis. True gallbladder polyps can be benign or malignant. Benign polyps are most commonly adenomas, while malignant polyps are adenocarcinomas and metastases. There are also rare types of benign and malignant true gallbladder polyps, including mesenchymal tumours and lymphomas. Ultrasound is the first-choice imaging method for the diagnosis of gallbladder polyps, representing an indispensable tool for ensuring appropriate management. It enables limitation of secondary level investigations and avoidance of unnecessary cholecystectomies.

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Weak Beam Imaging and Diffraction Studies of Stacking Faults in Silicon

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100092918 ◽

1976 ◽

Vol 34 ◽

pp. 590-591

Author(s):

T. Y. Tan ◽

W. K. Tice

Keyword(s):

Fast Neutron ◽

Rapid Determination ◽

Stacking Faults ◽

Imaging Method ◽

Large Reduction ◽

Dislocation Loops ◽

Fringe Spacing ◽

Weak Beam ◽

Kinematical Theory

In studying ion implanted semiconductors and fast neutron irradiated metals, the need for characterizing small dislocation loops having diameters of a few hundred angstrom units usually arises. The weak beam imaging method is a powerful technique for analyzing these loops. Because of the large reduction in stacking fault (SF) fringe spacing at large sg, this method allows for a rapid determination of whether the loop is faulted, and, hence, whether it is a perfect or a Frank partial loop. This method was first used by Bicknell to image small faulted loops in boron implanted silicon. He explained the fringe spacing by kinematical theory, i.e., ≃l/(Sg) in the fault fringe in depth oscillation. The fault image contrast formation mechanism is, however, really more complicated.

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Performance and applications of the holography electron microscope

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100151222 ◽

1993 ◽

Vol 51 ◽

pp. 1078-1079

Author(s):

Akira Tonomura

Keyword(s):

Electron Beam ◽

Electron Microscope ◽

Phase Measurement ◽

Electron Holography ◽

Imaging Method ◽

High Contrast ◽

Magnetic Lens ◽

High Brightness ◽

Holographic Imaging ◽

Dynamic Observation

Electron holography is a two-step imaging method. However, the ultimate performance of holographic imaging is mainly determined by the brightness of the electron beam used in the hologram-formation process. In our 350kV holography electron microscope (see Fig. 1), the decrease in the inherently high brightness of field-emitted electrons is minimized by superposing a magnetic lens in the gun, for a resulting value of 2 × 109 A/cm2 sr. This high brightness has lead to the following distinguished features. The minimum spacing (d) of carrier fringes is d = 0.09 Å, thus allowing a reconstructed image with a resolution, at least in principle, as high as 3d=0.3 Å. The precision in phase measurement can be as high as 2π/100, since the position of fringes can be known precisely from a high-contrast hologram formed under highly collimated illumination. Dynamic observation becomes possible because the current density is high.

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