今日の臨床サポート

胆嚢ポリープ・胆嚢腺筋腫症

著者: 乾和郎 藤田医科大学 ばんたね病院 消化器内科

監修: 田妻進 広島大学病院 総合内科・総合診療科

著者校正済:2021/12/01
現在監修レビュー中
患者向け説明資料

概要・推奨   

  1. 広基性で大きさが10mm以上の胆嚢ポリープを有する患者には、胆嚢摘出術を行うことが勧められる(推奨度1)。
  1. 有茎性で大きさ10mm以下、高エコーを呈する桑実状ポリープを有する患者は、1年後に腹部超音波検査を再検することが勧められる(推奨度1)。
  1. 胆嚢ポリープは人間ドックなどの腹部超音波検査で4.3~6.9%に認められる。一方、胆嚢癌は0.011%に発見されていることから、発見したときに正確な診断を行うことが勧められる(推奨度1)。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
乾和郎 : 未申告[2021年]
監修:田妻進 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った(2020年に出された胆嚢腺筋腫症に関する論文を追加した)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 胆嚢ポリープとは、胆嚢の内腔粘膜が一部隆起している状態であり、炎症性・過形成性およびコレステロール由来のものに分類される。一方、胆嚢腺筋腫症とは胆嚢壁に存在する憩室の一種であるロキタンスキー・アショフ洞が増殖・拡張し胆嚢壁が部分的あるいは全体的に肥厚する疾患である。
  1. 胆嚢ポリープの発見頻度は4.3~6.9%、胆嚢腺筋腫症の発見頻度は0.2~0.4%である[1]。胆嚢ポリープには、コレステロールポリープ、炎症性ポリープ、腺腫などがあり、最も頻度が高いのは、コレステロールポリープである。一方、胆嚢腺筋腫症は形態によってびまん型、分節型、限局型に分けられるが、胆嚢ポリープとの鑑別診断が問題となるのは限局型である。
  1. 2018年に出されたコクランによるシステマティックレビューでは、1000人の胆嚢ポリープ有病率は6.4%であったが、そのうち腫瘍性ポリープは10%であったと報告されている[2]
  1. 胆嚢癌は0.011%に発見されていることから、発見したときに正確な診断を行うことが勧められる。
 
胆嚢ポリープの種類

胆嚢ポリープの60%はコレステロールポリープで、限局型腺筋腫症は25%、炎症性ポリープは10%、腺腫は4%、その他の腫瘍は1%以下である。

 
  1. 腺腫は癌化の可能性があるが、コレステロールポリープ、炎症性ポリープは癌化の可能性はほとんどない。限局型腺筋腫症は頻度が低いものの癌合併の報告がある。
 
胆嚢腺筋腫症の分類

限局型:壁肥厚が限局して認められる。底部に多いので底部型とも呼ばれる。通常10~20mmである。びまん型:胆嚢全体に壁肥厚を認める。分節型:壁肥厚を1区域または2区域に認める。

出典

img1:  著者提供
 
 
問診・診察のポイント  
  1. 健康診断や他疾患の診察時などに腹部超音波検査を受けたことがないかを確認する。比較する画像があれば参考にする。

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文献 

著者: Kazuo Inui, Junji Yoshino, Hironao Miyoshi
雑誌名: Intern Med. 2011;50(11):1133-6. Epub 2011 Jun 1.
Abstract/Text Gallbladder cancer is among the organs examined in mass screening for cancer using ultrasonography; the reported prevalence of gallbladder cancer in such screening of a general population was 0.011%, while the prevalence of gallbladder polyps was reported as 4.3 to 6.9%. Endoscopic ultrasonography is useful for the differential diagnosis of gallbladder tumors detected by mass screening, as well as for estimating the depth of tumor invasion and detecting abnormal connections between pancreatobiliary ducts. While a systematic approach leading to diagnosis by endoscopic ultrasonography is useful, recent advances of contrast-enhanced ultrasonography are expected to establish it as a new modality for early detection. At our hospital, 7 of 26 patients with abnormal connections between pancreatobiliary ducts developed gallbladder carcinoma (23.1%), and 7 of 48 patients with gallbladder carcinoma had abnormal connections between pancreatobiliary ducts (12.5%). Serial observation in patients with gallstones and prophylactic surgery in patients with abnormal connections between pancreatobiliary ducts are necessary.

PMID 21628925  Intern Med. 2011;50(11):1133-6. Epub 2011 Jun 1.
著者: Sarah Z Wennmacker, Mark P Lamberts, Marcello Di Martino, Joost Ph Drenth, Kurinchi Selvan Gurusamy, Cornelis Jhm van Laarhoven
雑誌名: Cochrane Database Syst Rev. 2018 Aug 15;8:CD012233. doi: 10.1002/14651858.CD012233.pub2. Epub 2018 Aug 15.
Abstract/Text BACKGROUND: Approximately 0.6% to 4% of cholecystectomies are performed because of gallbladder polyps. The decision to perform cholecystectomy is based on presence of gallbladder polyp(s) on transabdominal ultrasound (TAUS) or endoscopic ultrasound (EUS), or both. These polyps are currently considered for surgery if they grow more than 1 cm. However, non-neoplastic polyps (pseudo polyps) do not need surgery, even when they are larger than 1 cm. True polyps are neoplastic, either benign (adenomas) or (pre)malignant (dysplastic polyps/carcinomas). True polyps need surgery, especially if they are premalignant or malignant. There has been no systematic review and meta-analysis on the accuracy of TAUS and EUS in the diagnosis of gallbladder polyps, true gallbladder polyps, and (pre)malignant polyps.
OBJECTIVES: To summarise and compare the accuracy of transabdominal ultrasound (TAUS) and endoscopic ultrasound (EUS) for the detection of gallbladder polyps, for differentiating between true and pseudo gallbladder polyps, and for differentiating between dysplastic polyps/carcinomas and adenomas/pseudo polyps of the gallbladder in adults.
SEARCH METHODS: We searched the Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded, and trial registrations (last date of search 09 July 2018). We had no restrictions regarding language, publication status, or prospective or retrospective nature of the studies.
SELECTION CRITERIA: Studies reporting on the diagnostic accuracy data (true positive, false positive, false negative and true negative) of the index test (TAUS or EUS or both) for detection of gallbladder polyps, differentiation between true and pseudo polyps, or differentiation between dysplastic polyps/carcinomas and adenomas/pseudo polyps. We only accepted histopathology after cholecystectomy as the reference standard, except for studies on diagnosis of gallbladder polyp. For the latter studies, we also accepted repeated imaging up to six months by TAUS or EUS as the reference standard.
DATA COLLECTION AND ANALYSIS: Two authors independently screened abstracts, selected studies for inclusion, and collected data from each study. The quality of the studies was evaluated using the QUADAS-2 tool. The bivariate random-effects model was used to obtain summary estimates of sensitivity and specificity, to compare diagnostic performance of the index tests, and to assess heterogeneity.
MAIN RESULTS: A total of 16 studies were included. All studies reported on TAUS and EUS as separate tests and not as a combination of tests. All studies were at high or unclear risk of bias, ten studies had high applicability concerns in participant selection (because of inappropriate participant exclusions) or reference standards (because of lack of follow-up for non-operated polyps), and three studies had unclear applicability concerns in participant selection (because of high prevalence of gallbladder polyps) or index tests (because of lack of details on ultrasound equipment and performance). A meta-analysis directly comparing results of TAUS and EUS in the same population could not be performed because only limited studies executed both tests in the same participants. Therefore, the results below were obtained only from indirect test comparisons. There was significant heterogeneity amongst all comparisons (target conditions) on TAUS and amongst studies on EUS for differentiating true and pseudo polyps.Detection of gallbladder polyps: Six studies (16,260 participants) used TAUS. We found no studies on EUS. The summary sensitivity and specificity of TAUS for the detection of gallbladder polyps was 0.84 (95% CI 0.59 to 0.95) and 0.96 (95% CI 0.92 to 0.98), respectively. In a cohort of 1000 people, with a 6.4% prevalence of gallbladder polyps, this would result in 37 overdiagnosed and seven missed gallbladder polyps.Differentiation between true polyp and pseudo gallbladder polyp: Six studies (1078 participants) used TAUS; the summary sensitivity was 0.68 (95% CI 0.44 to 0.85) and the summary specificity was 0.79 (95% CI 0.57 to 0.91). Three studies (209 participants) used EUS; the summary sensitivity was 0.85 (95% CI 0.46 to 0.97) and the summary specificity was 0.90 (95% CI 0.78 to 0.96). In a cohort of 1000 participants with gallbladder polyps, with 10% having true polyps, this would result in 189 overdiagnosed and 32 missed true polyps by TAUS, and 90 overdiagnosed and 15 missed true polyps by EUS. There was no evidence of a difference between the diagnostic accuracy of TAUS and EUS (relative sensitivity 1.06, P = 0.70, relative specificity 1.15, P = 0.12).Differentiation between dysplastic polyps/carcinomas and adenomas/pseudo polyps of the gallbladder: Four studies (1,009 participants) used TAUS; the summary sensitivity was 0.79 (95% CI 0.62 to 0.90) and the summary specificity was 0.89 (95% CI 0.68 to 0.97). Three studies (351 participants) used EUS; the summary sensitivity was 0.86 (95% CI 0.76 to 0.92) and the summary specificity was 0.92 (95% CI 0.85 to 0.95). In a cohort of 1000 participants with gallbladder polyps, with 5% having a dysplastic polyp/carcinoma, this would result in 105 overdiagnosed and 11 missed dysplastic polyps/carcinomas by TAUS and 76 overdiagnosed and seven missed dysplastic polyps/carcinomas by EUS. There was no evidence of a difference between the diagnostic accuracy of TAUS and EUS (log likelihood test P = 0.74).
AUTHORS' CONCLUSIONS: Although TAUS seems quite good at discriminating between gallbladder polyps and no polyps, it is less accurate in detecting whether the polyp is a true or pseudo polyp and dysplastic polyp/carcinoma or adenoma/pseudo polyp. In practice, this would lead to both unnecessary surgeries for pseudo polyps and missed cases of true polyps, dysplastic polyps, and carcinomas. There was insufficient evidence that EUS is better compared to TAUS in differentiating between true and pseudo polyps and between dysplastic polyps/carcinomas and adenomas/pseudo polyps. The conclusions are based on heterogeneous studies with unclear criteria for diagnosis of the target conditions and studies at high or unclear risk of bias. Therefore, results should be interpreted with caution. Further studies of high methodological quality, with clearly stated criteria for diagnosis of gallbladder polyps, true polyps, and dysplastic polyps/carcinomas are needed to accurately determine diagnostic accuracy of EUS and TAUS.

PMID 30109701  Cochrane Database Syst Rev. 2018 Aug 15;8:CD012233. doi・・・
著者: T Jørgensen, K H Jensen
雑誌名: Scand J Gastroenterol. 1990 Mar;25(3):281-6.
Abstract/Text The prevalence of gallbladder polyps as assessed by ultrasonography in a random population was 4.6% among men and 4.3% among women. The size of most polyps was 3 mm or more but never exceeded 10 mm. The prevalence of polyps was not significantly associated with age, sex, social factors, weight factors, physical activity, diabetes mellitus, pregnancies, use of exogenous female hormones, intake of alcohol, or plasma lipids. Polyps among men were significantly associated with a history of no smoking. This lack of risk factor profile resembled that of cholesterolosis, as seen in the literature, whereas it was quite different from that of gallstones. It is concluded that polyps in the gallbladder are common in a random population, and, although it is known from the literature that some cases may represent gallstones, the vast majority most probably represent the polypoid variation of cholesterolosis.

PMID 2320947  Scand J Gastroenterol. 1990 Mar;25(3):281-6.
著者: K Segawa, T Arisawa, Y Niwa, T Suzuki, Y Tsukamoto, H Goto, E Hamajima, M Shimodaira, N Ohmiya
雑誌名: Am J Gastroenterol. 1992 May;87(5):630-3.
Abstract/Text The prevalence of gallbladder polyps was investigated in apparently healthy Japanese who underwent abdominal ultrasonography as part of their health screening examination. The polyps found were differentiated from gallstones, adenomas, or carcinomas as much as possible, and were considered to be cholesterol polyps. The prevalence of such gallbladder polyps was higher among males in every decade of age evaluated. The subjects with gallbladder polyps were more obese than the control group without gallbladder polyps, on abdominal ultrasonograms. The prevalence of gallbladder polyps rose in accordance with a rise in obesity index. At each range of obesity index, the prevalence of gallbladder polyps was higher among males. The prevalence of gallbladder polyps was highest among the middle-aged (40- and 50-yr-old) males, similar to the curve of the obesity index. In females, the obesity index increased with age, with no accompanying rise in the prevalence of gallbladder polyps. These data suggest that obesity contributes to the formation of cholesterol polyps of the gallbladder.

PMID 1595653  Am J Gastroenterol. 1992 May;87(5):630-3.
著者: C Y Chen, C L Lu, F Y Chang, S D Lee
雑誌名: Am J Gastroenterol. 1997 Nov;92(11):2066-8.
Abstract/Text OBJECTIVES: To assess the prevalence of and risk factors for gallbladder (GB) polyps in the Chinese population.
METHODS: A prospective ultrasonographic study of GB polyps was conducted in 3647 Chinese subjects who received a paid physical checkup at this hospital. Their demographic characteristics and biochemical parameters were recorded. Ultrasonographic diagnosis revealed a normal GB in 2946 subjects (1838 men, 1108 women), polyps in 243 (174 men, 69 women), gallstones in 286 (196 men, 90 women), a history of cholecystectomy in 100 (56 men, 44 women), mixed gallstones/GB polyps in 17 (10 men, seven women), and miscellaneous results in 35.
RESULTS: Excluding subjects with cholecystectomy and mixed gallstones/GB polyps, the overall prevalence of GB polyps in the study group was 6.9%. The studied risk factors manifesting an increased odds ratio (OR) for the development of GB polyps were glucose intolerance (OR 1.506, p < 0.05) and male gender (OR 1.723, p < 0.05) in multivariate analysis. Other demographic characteristics and biochemical parameters, such as age, body mass index, cigarette smoking, alcohol consumption, blood pressure, lipid profile, hepatitis B virus carrier, liver function, and parity, did not exhibit any correlation to GB polyps.
CONCLUSIONS: Among Chinese of higher socioeconomic status, men and individuals with glucose intolerance tend to have a high risk for developing GB polyps.

PMID 9362194  Am J Gastroenterol. 1997 Nov;92(11):2066-8.
著者: Robert P Myers, Eldon A Shaffer, Paul L Beck
雑誌名: Can J Gastroenterol. 2002 Mar;16(3):187-94.
Abstract/Text Polypoid lesions of the gallbladder affect approximately 5% of the adult population. Most affected individuals are asymptomatic, and their gallbladder polyps are detected during abdominal ultrasonography performed for unrelated conditions. Although the majority of gallbladder polyps are benign, most commonly cholesterol polyps, malignant transformation is a concern. The differentiation of benign from malignant lesions can be challenging. Several features, including patient age, polyp size and number, and rapid growth of polyps, are important discriminating features between benign and malignant polyps. Based on the evidence highlighted in this review, the authors recommend resection in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, greater than 10 mm in diameter, or associated with gallstones or polyp growth on serial ultrasonography. Novel imaging techniques, including endoscopic ultrasonography and enhanced computed tomography, may aid in the differential diagnosis of these lesions and permit expectant management.

PMID 11930198  Can J Gastroenterol. 2002 Mar;16(3):187-94.
著者: T Azuma, T Yoshikawa, T Araida, K Takasaki
雑誌名: Am J Surg. 2001 Jan;181(1):65-70.
Abstract/Text BACKGROUND: Transabdominal ultrasonography (US) has made the detection of gallbladder polyps easier, but the differential diagnosis of polyps less than 20 mm remains difficult. Therefore, we evaluated the usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of gallbladder polyps.
METHODS: Among patients with gallbladder polyps less than 20 mm, we reviewed 89 patients who underwent US and EUS before surgery and assessed the results of differential diagnoses by them.
RESULTS: In all, 86.5% of these polyps were precisely diagnosed by EUS. However, only 51.7% were diagnosed by US. Sensitivity, specificity, and positive and negative predictive values of EUS at the diagnosis of carcinoma were 91.7%, 87.7%, 75.9%, and 96.6%, respectively. Those of US were 54.2%, 53.8%, 54.2%, and 94.6%, respectively.
CONCLUSIONS: EUS may markedly improve the accuracy of the differential diagnosis of gallbladder polyps. Therefore, EUS is thought to play an important role in determining the treatment strategy for gallbladder polyps.

PMID 11248179  Am J Surg. 2001 Jan;181(1):65-70.
著者: K Kimura, N Fujita, Y Noda, G Kobayashi, K Ito
雑誌名: J Gastroenterol. 2001 Sep;36(9):619-22.
Abstract/Text PURPOSE: We have previously reported the effectiveness of endoscopic ultrasonography (EUS) for the differential diagnosis of pedunculated polypoid lesions of the gallbladder, based on retrospective studies using resected specimens. We proposed the following diagnostic criteria for EUS findings: when the contour of a lesion is nodular or smooth, the lesion is diagnosed as a neoplasm, and when a lesion has a granular contour, it is diagnosed as a nonneoplasm. The present study was designed to verify the clinical utility of our EUS ctiteria prospectively.
METHODS: Forty-six consecutive patients with pedunculated polypoid lesions of the gallbladder 10mm or greater in size diagnosed as nonneoplasms at the initial EUS, all of whom underwent follow-up examinations, were enrolled in this study. The occurrence of changes in these lesions during the observation period was examined.
RESULTS: No evident changes in lesions were observed in 43 of the 46 patients. Spontaneous self-detachment of lesions was recognized during the observation period in the other 3 patients.
CONCLUSIONS: EUS is useful for determining treatment indications for pedunculated polypoid lesions of the gallbladder, even when the lesions are large, and contributes to avoiding unnecessary surgery.

PMID 11578066  J Gastroenterol. 2001 Sep;36(9):619-22.
著者: M Sugiyama, X Y Xie, Y Atomi, M Saito
雑誌名: Ann Surg. 1999 Apr;229(4):498-504.
Abstract/Text OBJECTIVE: To evaluate the accuracy of endoscopic ultrasonography (EUS) in making a differential diagnosis of small (< or =20 mm) polypoid lesions of the gallbladder.
SUMMARY BACKGROUND DATA: Differential diagnosis of these lesions is often difficult using conventional imaging modalities.
METHODS: The findings of EUS and transabdominal ultrasonography were retrospectively analyzed in 65 surgical cases of small polypoid lesions (cholesterol polyp in 40, adenomyomatosis in 9, adenoma in 4, and adenocarcinoma in 12).
RESULTS: Polypoid lesions exceeding 10 mm suggested malignancy. EUS showed a tiny echogenic spot or an aggregation of echogenic spots with or without echopenic areas in 95% of patients with cholesterol polyps. EUS showed multiple microcysts or comet tail artifact in all adenomyomatosis cases. Adenomas and adenocarcinomas were not associated with the echogenic spots, microcysts, or artifacts. Among adenomas and adenocarcinomas, all sessile lesions were adenocarcinomas. EUS differentiated among polypoid lesions more precisely than ultrasonography (97% vs. 71%).
CONCLUSIONS: A tiny echogenic spot or an aggregation of echogenic spots and multiple microcysts or comet tail artifact is pathognomonic for cholesterol polyp and adenomyomatosis, respectively. Polypoid lesions without these findings indicate adenoma or adenocarcinoma on EUS. Routine use of EUS is recommended for differential diagnosis of polypoid gallbladder lesions when ultrasonography shows no signs indicative of either cholesterol polyp or adenomyomatosis.

PMID 10203082  Ann Surg. 1999 Apr;229(4):498-504.
著者: M Mitake, S Nakazawa, Y Naitoh, E Kimoto, Y Tsukamoto, T Asai, K Yamao, K Inui, K Morita, Y Hayashi
雑誌名: Gastrointest Endosc. 1990 Nov-Dec;36(6):562-6.
Abstract/Text Endoscopic ultrasonography (EUS) was performed preoperatively in 39 patients with gallbladder carcinoma. Diagnosis of the anatomical extent of gallbladder carcinoma was compared with histologic analysis, and staging accuracy was evaluated according to the TNM classification. Carcinoma considered to be at an early stage with no lymph node metastasis was correctly diagnosed in 87.5%. Differential diagnosis between early and advanced staged tumors was possible in 79.5%. Overall accuracy for depth of tumor invasion (T) was 76.9%. Limitations were due to many stones in the gallbladder and microinfiltration of carcinoma. Assessment of regional lymph node metastasis (N) was at a sensitivity of 81.8% and specificity of 92.9%, for an overall accuracy of 89.7%. We believe endoscopic ultrasonography is useful in the clinical staging of gallbladder carcinoma.

PMID 2279643  Gastrointest Endosc. 1990 Nov-Dec;36(6):562-6.
著者: K Kimura
雑誌名: Nihon Shokakibyo Gakkai Zasshi. 1997 Apr;94(4):249-60.
Abstract/Text Establishment of an appropriate diagnostic criteria for differential diagnosis in pedunculated polypoid lesions of the gallbladder by endoscopic ultrasonography (EUS) was attempted. There was a significant difference in the contour and the internal echo pattern shown by EUS between neoplasms and non-neoplasms. The characteristic findings of neoplasms were a nodular or smooth contour and a solid internal echo, while those of non-neoplasms were a granular contour and a spotty internal echo. The contour shown by EUS especially well reflected the gross appearance. Assessment of the contour of lesions was the most reliable in differential diagnosis between neoplasms and non-neoplasms, for example, I p-type carcinomas and large cholesterol polyps; such differential diagnosis is clinically important. It was thought to be reasonable to establish a diagnostic criteria based on EUS findings: if the contour of a lesion is smooth or nodular, the lesion is classified as a neoplasm, and if the contour of a lesion is granular, the lesion is diagnosed as a non-neoplasm.

PMID 9136581  Nihon Shokakibyo Gakkai Zasshi. 1997 Apr;94(4):249-60.
著者: Young Koog Cheon, Won Young Cho, Tae Hee Lee, Young Deok Cho, Jong Ho Moon, Joon Seong Lee, Chan Sup Shim
雑誌名: World J Gastroenterol. 2009 May 21;15(19):2361-6. doi: 10.3748/wjg.15.2361.
Abstract/Text AIM: To assess the ability of endoscopic ultrasonography (EUS) to differentiate neoplastic from non-neoplastic polypoid lesions of the gallbladder (PLGs).
METHODS: The uses of EUS and transabdominal ultrasonography (US) were retrospectively analyzed in 94 surgical cases of gallbladder polyps less than 20 mm in diameter.
RESULTS: The prevalence of neoplastic lesions with a diameter of 5-10 mm was 17.2% (10/58); 11-15 mm, 15.4% (4/26), and 16-20 mm, 50% (5/10). The overall diagnostic accuracies of EUS and US for small PLGs were 80.9% and 63.9% (P < 0.05), respectively. EUS correctly distinguished 12 (63.2%) of 19 neoplastic PLGs but was less accurate for polyps less than 1.0 cm (4/10, 40%) than for polyps greater than 1.0 cm (8/9, 88.9%) (P = 0.02).
CONCLUSION: Although EUS was more accurate than US, its accuracy for differentiating neoplastic from non-neoplastic PLGs less than 1.0 cm was low. Thus, EUS alone is not sufficient for determining a treatment strategy for PLGs of less than 1.0 cm.

PMID 19452579  World J Gastroenterol. 2009 May 21;15(19):2361-6. doi: ・・・
著者: Su Young Kim, Jae Hee Cho, Eui Joo Kim, Dong Hae Chung, Kun Kuk Kim, Yeon Ho Park, Yeon Suk Kim
雑誌名: Eur Radiol. 2018 May;28(5):1994-2002. doi: 10.1007/s00330-017-5175-3. Epub 2017 Dec 7.
Abstract/Text OBJECTIVES: We evaluated the usefulness of real-time colour Doppler flow (CDF) endoscopic ultrasonography (EUS) for differentiating neoplastic gallbladder (GB) polyps from non-neoplastic polyps.
METHODS: Between August 2014 and December 2016, a total of 233 patients with GB polyps who underwent real-time CDF-EUS were consecutively enrolled in this prospective study. CDF imaging was subjectively categorized for each patient as: strong CDF pattern, weak CDF pattern and no CDF pattern.
RESULTS: Of the 233 patients, 115 underwent surgical resection. Of these, there were 90 cases of non-neoplastic GB polyps and 23 cases of neoplastic GB polyps. In a multivariate analysis, a strong CDF pattern was the most significant predictive factor for neoplastic polyps; sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 52.2 %, 79.4 %, 38.7 %, 86.9 % and 73.9 %, respectively. Solitary polyp and polyp size were associated with an increased risk of neoplasm.
CONCLUSIONS: The presence of a strong CDF pattern as well as solitary and larger polyps on EUS may be predictive of neoplastic GB polyps. As real-time CDF-EUS poses no danger to the patient and requires no additional equipment, it is likely to become a supplemental tool for the differential diagnosis of GB polyps.
KEY POINTS: • Differential diagnosis between neoplastic polyps and non-neoplastic polyps of GB is limited. • The use of real-time CDF-EUS was convenient, with high agreement between operators. • The real-time CDF-EUS is helpful in differential diagnosis of GB polyps.

PMID 29218621  Eur Radiol. 2018 May;28(5):1994-2002. doi: 10.1007/s003・・・
著者: H Furukawa, T Kosuge, K Shimada, J Yamamoto, Y Kanai, K Mukai, R Iwata, K Ushio
雑誌名: Arch Surg. 1998 Jul;133(7):735-9.
Abstract/Text OBJECTIVES: To demonstrate the helical computed tomographic (CT) features of small polypoid lesions of the gallbladder and to establish a clinical strategy based on CT findings for the treatment of such lesions.
DESIGN: Validation cohort study.
SETTING: Tertiary care public hospital.
PATIENTS: Thirty-one patients with polypoid lesions of the gallbladder (< or = 3 cm) underwent CT followed by resection.
MAIN OUTCOME MEASURE: The detectability of the lesions on both unenhanced and enhanced CT and the configuration of the lesions on enhanced CT were prospectively evaluated in comparison with the histopathological findings.
RESULTS: Unenhanced CT detected 14 (45%) of the 31 lesions, whereas enhanced CT detected all of the lesions. The detection rates of the neoplastic lesions (adenoma, adenocarcinoma, and metastatic tumor) and cholesterol polyps were 81% (13/16) and 7% (1/15), respectively (P<.001). Among the 20 lesions demonstrated as pedunculated, 6 (30%) were neoplastic, whereas 10 (91%) of the 11 lesions demonstrated as sessile were neoplastic (P<.001). When a lesion was demonstrated on unenhanced CT or its shape was sessile on enhanced CT, the case was diagnosed as a neoplastic lesion. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the CT diagnosis of the neoplastic lesions were 88% (14/16), 87% (13/15), 88% (14/16), 87% (13/15), and 87% (27/31), respectively.
CONCLUSION: Computed tomography can differentiate neoplastic and nonneoplastic small polypoid lesions of the gallbladder and reliably identify the presence of neoplastic lesions that should be resected.

PMID 9688001  Arch Surg. 1998 Jul;133(7):735-9.
著者: Ko Woon Park, Seong Hyun Kim, Seong Ho Choi, Won Jae Lee
雑誌名: J Comput Assist Tomogr. 2010 Jan;34(1):135-9. doi: 10.1097/RCT.0b013e3181b382d7.
Abstract/Text OBJECTIVE: To evaluate useful computed tomographic features to differentiate nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger.
METHODS: Thirty-one patients with 32 nonneoplastic polyps and 67 patients with 73 neoplastic polyps 1 cm or bigger underwent unenhanced and dual-phase (arterial and portal venous phases) multi-detector row computed tomography. Gallbladder polyps were diagnosed by cholecystectomy. Computed tomographic features including size (1.5 cm), surface (smooth or irregular), shape (pedunculated or sessile), accompanying wall thickening, basal indentation, perception on unenhanced images, and enhancement pattern between 2 groups were compared using univariate and multivariate analyses.
RESULTS: On univariate analysis, age 55 years or older (P = 0.0019), size bigger than 1.5 cm (P < 0.0001), irregular surface (P = 0.0033), sessile shape (P = 0.0016), accompanying wall thickening (P = 0.0056), basal indentation (P = 0.0236), and perception on unenhanced images (P < 0.0001) were significantly more frequent in neoplastic polyps as compared with nonneoplastic polyps. On multivariate analysis, size bigger than 1.5 cm (P = 0.0260), sessile shape (P = 0.0397), and perception on unenhanced images (P < 0.0001) were statistically significant.
CONCLUSIONS: Size bigger than 1.5 cm, sessile shape, and perception on unenhanced images are the main factors that differentiate neoplastic from nonneoplastic gallbladder polyps 1 cm or bigger.

PMID 20118736  J Comput Assist Tomogr. 2010 Jan;34(1):135-9. doi: 10.1・・・
著者: Wei Zhou, Guichen Li, Ling Ren
雑誌名: J Am Coll Surg. 2017 Aug;225(2):243-248. doi: 10.1016/j.jamcollsurg.2017.04.014. Epub 2017 Apr 25.
Abstract/Text BACKGROUND: With triphasic, dynamic contrast-enhanced CT scan to identify benign and malignant gallbladder polypoid lesions, we hope to determine an accurate diagnosis before surgery.
STUDY DESIGN: Ninety patients with gallbladder polypoid lesions were treated surgically in the Department of Hepatobiliary Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China, from July 2013 to July 2016, and divided into 2 groups according to postoperative pathologic results: a malignant group with 44 patients and a benign group with 46 patients. Triphasic, dynamic contrast-enhanced CT scan was performed in 90 patients within 2 weeks before surgery. The CT image parameters were measured and analyzed by 2 senior radiologists and a hepatobiliary surgeon in blind.
RESULTS: Mean age of the malignant group was significantly older than that of the benign lesion group (p < 0.01). With the CT image parameters, the maximal diameter of the lesion was significantly longer in malignant lesions than in benign lesions (p < 0.01). There was a significant difference in plain CT, delayed phase CT, and ΔCT values (ΔCT = portal venous phase CT value minus delayed phase CT value) between the 2 groups (all p < 0.01). In terms of differentiating malignant and benign gallbladder polypoid lesions, the ΔCT value was superior to that of plain and delayed phase CT in both sensitivity and specificity (p < 0.05).
CONCLUSIONS: In triphasic, dynamic contrast-enhanced CT scan, plain CT value, delayed phase CT value, and ΔCT value could detect malignant lesions of gallbladder polyps, with the highest sensitivity and specificity of ΔCT.

Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
PMID 28455251  J Am Coll Surg. 2017 Aug;225(2):243-248. doi: 10.1016/j・・・
著者: K Yoshimitsu, H Honda, K Kaneko, T Kuroiwa, H Irie, T Ueki, K Chijiiwa, K Takenaka, K Masuda
雑誌名: J Magn Reson Imaging. 1997 Jul-Aug;7(4):696-701.
Abstract/Text Forty-nine pathologically proven gallbladder lesions were evaluated in 45 patients using dynamic MRI with a spoiled gradient pulse sequence (SPGR), to access the ability of this technique to differentiate benign from malignant gallbladder lesions. The studies were reviewed retrospectively. Signal intensity of the lesions were measured. Twenty-one malignant and 28 benign lesions were classified into three categories: polypoid, diffuse wall thickening, and exophytic. Early and delayed enhancement patterns were evaluated. For the polypoid masses, malignant lesions (n = 9) demonstrated early and prolonged enhancements, whereas benign lesions (n = 14) had early enhancement with subsequent washout (P < .05). For diffuse gallbladder wall thickening, malignant lesions (n = 6) demonstrated early and prolonged enhancement and benign lesions (n = 14) showed relatively slow, prolonged enhancement (P < .05). The exophytic masses (n = 6) all were malignant and demonstrated early and prolonged enhancement. Dynamic MRI can help differentiate benign from malignant gallbladder lesions.

PMID 9243391  J Magn Reson Imaging. 1997 Jul-Aug;7(4):696-701.
著者: K Yoshimitsu, H Honda, M Jimi, T Kuroiwa, K Hanada, H Irie, T Tajima, M Takashima, K Chijiiwa, M Shimada, K Masuda
雑誌名: AJR Am J Roentgenol. 1999 Jun;172(6):1535-40. doi: 10.2214/ajr.172.6.10350285.
Abstract/Text OBJECTIVE: We evaluated the MR imaging features of adenomyomatosis of the gallbladder with particular emphasis on Rokitansky-Aschoff sinuses.
MATERIALS AND METHODS: MR images of 17 patients with histologically proven adenomyomatosis were retrospectively reviewed. The presence of Rokitansky-Aschoff sinuses was evaluated and analyzed; four T2-weighted (fast spin-echo with a surface coil, with or without breath-holding, fast spin-echo with a phased-array coil with breath-holding, and half-Fourier rapid acquisition with relaxation enhancement with breath-holding) and two contrast-enhanced dynamic pulse sequences were studied. These six pulse sequences were separately rated on a 5-point scale by two radiologists for comparison. Interobserver differences were evaluated. Other MR findings were also analyzed.
RESULTS: Among the six pulse sequences studied, three T2-weighted with breath-holding sequences were found to be superior to the other three sequences in showing Rokitansky-Aschoff sinuses. In particular, the half-Fourier rapid acquisition with relaxation enhancement was scored the highest by the two observers and received the highest kappa coefficient in our statistical analysis of the scoring. Diffuse-type adenomyomatosis typically showed early mucosal and subsequent serosal enhancement. Localized adenomyomatosis exhibited homogeneous enhancement, showing smooth continuity with the surrounding gallbladder epithelium.
CONCLUSION: MR imaging may be able to provide important information in the diagnosis of adenomyomatosis.

PMID 10350285  AJR Am J Roentgenol. 1999 Jun;172(6):1535-40. doi: 10.2・・・
著者: T Takashima, S Nakazawa, J Yoshino, K Inui, N Kanemaki, T Wakabayashi, K Okushima, T Kobayashi, Y Nakamura, H Ukai, T Hattori, H Miyoshi, H Anno
雑誌名: Nihon Shokakibyo Gakkai Zasshi. 1998 May;95(5):424-31.
Abstract/Text We studied 32 patients with the thickened lesions of the wall of the gallbladder by using dynamic MRI. We tried the differential diagnosis of gallbladder lesions according to the time intensity curve (TIC) and enhanced pattern. TIC of carcinoma was elevated more seeply from plain to arterial phase than the inflammatory diseases. The Inflammatory diseases were keeping three-layer structures of the wall of the gallbladder, but gallbladder carcinoma destroys the wall-structure. We could diagnose as direct liver invasion of the carcinoma clearly. We could exactly diagnose adenomyomatosis in dynamic MRI by small low intensity spots within the wall of the gallbladder. In the patients with gall stones, the wall of the gallbladder were more clearly observed in dynamic MRI compared with US and EUS.

PMID 9621698  Nihon Shokakibyo Gakkai Zasshi. 1998 May;95(5):424-31.
著者: Hiroyuki Irie, Noriyuki Kamochi, Junichi Nojiri, Yoshiaki Egashira, Kohei Sasaguri, Sho Kudo
雑誌名: Acta Radiol. 2011 Apr 1;52(3):236-40. doi: 10.1258/ar.2010.100234. Epub 2011 Mar 3.
Abstract/Text BACKGROUND: Several studies have reported the effectiveness of high b-value diffusion-weighted MR imaging (DWI) in the abdominal region, and have found that various malignant tumors may show high signal intensity on DWI, reflecting their high cellularity and/or their long relaxation time. The value of ADC measurement has also been documented for the diagnosis of several abdominal malignancies.
PURPOSE: To retrospectively evaluate the usefulness of high b-value DWI in differentiating between benign and malignant polypoid gallbladder lesions.
MATERIAL AND METHODS: The study population consisted of 10 benign (three hyperplastic polyps and seven adenomas) and 13 malignant (all adenocarcinomas) polypoid gallbladder lesions. DWI was evaluated by two observers. Qualitatively, the signal intensity of the lesions on DWI was visually evaluated and categorized as iso, high, or very high. Quantitatively, the ADC values of the lesions were measured from ADC maps. Statistical analysis was performed using a two-tailed Fisher's exact test and the Mann-Whitney test, respectively.
RESULTS: Qualitative analysis revealed a statistical difference (P = 0.0041). Six of 10 benign lesions were categorized as iso, and the remaining four were categorized as high. In the 13 malignant lesions, one was categorized as iso, five as high, and seven as very high. The ADC values of the malignant lesions (1.34 ± 0.50 × 10(-3) mm(2)/sec) were significantly lower than those of the benign lesions (2.26 ± 0.44 × 10(-3) mm(2)/sec) (P = 0.00016).
CONCLUSION: High b-value DWI may be useful for differentiating between benign and malignant polypoid gallbladder lesions by the visual assessment of DWI and ADC measurement.

PMID 21498356  Acta Radiol. 2011 Apr 1;52(3):236-40. doi: 10.1258/ar.2・・・
著者: Masashi Hattori, Kazuo Inui, Junji Yoshino, Hironao Miyoshi, Kazumu Okushima, Yuta Nakamura, Takehito Naito, Yoshihiro Imaeda, Yoshimune Horibe, Toshiyuki Hattori, Saburou Nakazawa
雑誌名: Nihon Shokakibyo Gakkai Zasshi. 2007 Jun;104(6):790-8.
Abstract/Text We investigated the usefulness of contrast-enhanced ultrasonography for differential diagnosis of polypoid gallbladder lesions in 60 patients, consisting of gallbladder carcinoma in 20, adenoma in 2, benign polyp in 29, and adenomyomatosis in 9, comparing contrast enhancement patterns with pathologic findings. We monitored vascular flow for 120 sec, constructing a time intensity curve (TIC) by flash-echo imaging. We compared the number of vessels and vessel diameter determined by contrast enhancement patterns and by pathologic examination. Contrast enhancement patterns were classified as linear, scattered, diffuse, or branched. When diffuse type and branched type were considered as indicative of cancer, accuracy was 84.5%, sensitivity 100%, and specificity 76.9%. In gallbladder carcinoma, the TIC rose from no contrast to early-phase contrast sooner than in other diseases. In adenocarcinoma, high-intensity values persisted at 120 sec. With an intensity of 90 or greater at 120 sec taken as indicating cancer, accuracy was 89.7%, sensitivity 89.5%, and specificity 89.7%; Vessels were significantly more numerous in diffuse type cases than in those with other patterns. Vessel diameter was greatest in the diffuse type and the branched type patterns, both differing significantly from the linear type. Ultrasonographic contrast enhancement patterns show characteristic associations with pathologic findings and serve as valuable adjuncts in the diagnosis of gallbladder diseases.

PMID 17548945  Nihon Shokakibyo Gakkai Zasshi. 2007 Jun;104(6):790-8.
著者: Tatsuo Inoue, Masayuki Kitano, Masatoshi Kudo, Hiroki Sakamoto, Toshihiko Kawasaki, Chikao Yasuda, Kiyoshi Maekawa
雑誌名: Ultrasound Med Biol. 2007 Mar;33(3):353-61. doi: 10.1016/j.ultrasmedbio.2006.09.003.
Abstract/Text We evaluated the usefulness of contrast-enhanced ultrasonography(US) for detecting and differentiating gallbladder lesions. Contrast-enhanced coded phase-inversion harmonic US was performed on 90 patients with gallbladder abnormalities. After administering Levovist, we observed the gallbladders in real time. Contrast-enhanced coded phase-inversion harmonic ultrasonography was compared with B-mode US and contrast-enhanced computer tomography (CT) with regard to the sensitivity and specificity in depicting the elevated gallbladder lesions. Furthermore, we assessed how the vascular patterns of the elevated gallbladder lesions depicted by contrast-enhanced US correlated with the diagnosis. Contrast-enhanced US efficiently discriminated true lesions from biliary sludge, unlike B-mode US. Consequently, contrast-enhanced US was more specific (100%) than B-mode US (81%), although their sensitivities were similar (98% and 96%, respectively). Contrast-enhanced US was also more sensitive that contrast-enhanced CT (98% versus 79%), although the two methods were equally sensitive (100% versus 95%). We classified the vascular patterns of the abnormalities depicted by contrast-enhanced US in the 90 cases into types 1 to 4, which represent branch-like, heterogeneous, homogeneous, and avascular patterns, respectively. All type 1 and 2 lesions were over 10 mm in size while most (88%) type 3 lesions were 10 mm or less in size. While the majority of carcinomas (86%) were type 1 or 2, three benign lesions also showed these patterns. Thus, the vascular pattern may simply reflect the size of the lesion and therefore its usefulness in diagnosing gallbladder lesions may be limited. Nevertheless, contrast-enhanced US is clearly superior to the other techniques in discriminating biliary sludge from other lesions.

PMID 17280766  Ultrasound Med Biol. 2007 Mar;33(3):353-61. doi: 10.101・・・
著者: Shujiro Tsuji, Atsushi Sofuni, Fuminori Moriyasu, Fumihide Itokawa, Kentaro Ishii, Toshio Kurihara, Takayoshi Tsuchiya, Nobuhito Ikeuchi, Junko Umeda, Reina Tanaka, Takao Itoi
雑誌名: Hepatogastroenterology. 2012 Mar-Apr;59(114):336-40. doi: 10.5754/hge11447.
Abstract/Text BACKGROUND/AIMS: The aim of our study was to evaluate the enhancement patterns of gallbladder disease using contrast-enhanced ultrasonography (CE-US) with the contrast agent levovist.
METHODOLOGY: The subjects were 42 patients, of whom 25 had gallbladder cancer, 2 had adenoma, 5 had adenomyomatosis, 5 had cholesterol polyps and 5 had debris. We assessed the enhancement patterns of each case using CE-US with levovist and classified these patterns into 6 types: diffuse, scattered, branched, linear, homogeneous and unenhanced.
RESULTS: The enhancement of gallbladder cancer revealed various patterns. Only 4 malignant cases showed branched patterns. We speculated that branched patterns in the present study were possibly the characteristic of malignancy. CE-US easily distinguished a small polypoid lesion from debris. Using CE-US, we visualized the shape of the gallbladder cancer lesions and some areas of direct invasion to the liver, as well as metastasis.
CONCLUSIONS: CE-US is a minimally invasive diagnostic technique that is useful in visualizing not only the shape of the lesion and some areas of the direct invasion to the liver, but also metastasis. The above findings suggest that imaging using a contrast agent could lead to improvements in the diagnosis of gallbladder lesions.

PMID 21940376  Hepatogastroenterology. 2012 Mar-Apr;59(114):336-40. do・・・
著者: Xiang Fei, Wen-Ping Lu, Yu-Kun Luo, Jian-Hon Xu, Yan-Mi Li, Huai-Yin Shi, Zi-Yu Jiao, Hong-tian Li
雑誌名: Abdom Imaging. 2015 Oct;40(7):2355-63. doi: 10.1007/s00261-015-0485-x.
Abstract/Text PURPOSE: The aim of this study was to find the independent risk factors related with gallbladder (GB) adenoma compared to cholesterol polyp by contrast-enhanced ultrasound (CEUS).
MATERIALS AND METHODS: Between January 2010 and September 2014, a total of 122 consecutive patients undergoing cholecystectomy for GB polypoid lesions were enrolled. Before cholecystectomy, each patient underwent conventional US and CEUS examination and all image features were documented. The patients were divided into adenoma group and cholesterol polyp group according to the pathological findings. All the image features between two groups were statistically compared.
RESULTS: There were differences in patient age, lesion size, echogenicity, and vascularity of lesion between two groups (P < 0.05). There were differences in stalk width and enhancement intensity between the two groups (P < 0.05). Multiple logistic regression analysis proved that enhancement intensity, stalk of lesion, and vascularity were the independent risk factors related with GB adenoma (P < 0.05).
CONCLUSIONS: CEUS could offer useful information to distinguish adenoma from cholesterol polyp. The treatment algorithm for gallbladder polyp lesions would likely benefit from CEUS as a routine imaging investigation, especially in cases where the polyp is larger than 1 cm.

PMID 26082060  Abdom Imaging. 2015 Oct;40(7):2355-63. doi: 10.1007/s00・・・
著者: Xue-Song Liu, Li-Hong Gu, Jing Du, Feng-Hua Li, Jian Wang, Tao Chen, Yun-He Zhang
雑誌名: J Ultrasound Med. 2015 Jun;34(6):1061-9. doi: 10.7863/ultra.34.6.1061.
Abstract/Text OBJECTIVES: The purpose of this study was to evaluate the usefulness of real-time contrast-enhanced sonography and microvascular imaging for differential diagnosis of neoplastic and non-neoplastic polypoid lesions of the gallbladder.
METHODS: Real-time contrast-enhanced sonography and microvascular imaging were performed in 128 patients with polypoid lesions of the gallbladder larger than 6 mm in diameter. The enhancement patterns, microvascular imaging types, and kinetic parameters were analyzed on contrast-enhanced sonography. The maximum diameters of the lesions measured by conventional and contrast-enhanced sonography were also recorded and subjected to a comparative analysis.
RESULTS: Among the 128 patients, histologic diagnoses were obtained in 83 (27 neoplastic lesions and 56 non-neoplastic lesions), which constituted the study group. On contrast-enhanced sonography, mild enhancement and absence of contrast were more easily found in non-neoplastic lesions (12 [21.4%]), whereas all neoplastic lesions showed marked enhancement (27 [100%]; P = .006). Of the 27 neoplastic lesions, 6 malignant tumors showed a perfusion defect on contrast-enhanced sonography, whereas none of the non-neoplastic lesions showed a perfusion defect (P = .003). The microvascular architecture of the lesions was categorized into 4 types: spotty, linear, branched, and spinous, and there were significant differences between the groups (P< .001). In a kinetic evaluation, none of the parameters reached statistical significance (all P> .05). There was a discrepancy in maximum diameters between conventional and contrast-enhanced sonography in both groups but the discrepancy was significantly greater in the non-neoplastic group (P = .026).
CONCLUSIONS: Contrast-enhanced sonography is a useful imaging technique and an adjunct to conventional sonography for differential diagnosis of neoplastic and non-neoplastic polypoid lesions of the gallbladder.

© 2015 by the American Institute of Ultrasound in Medicine.
PMID 26014326  J Ultrasound Med. 2015 Jun;34(6):1061-9. doi: 10.7863/u・・・
著者: K S Mainprize, S W Gould, J M Gilbert
雑誌名: Br J Surg. 2000 Apr;87(4):414-7. doi: 10.1046/j.1365-2168.2000.01363.x.
Abstract/Text BACKGROUND: With improvements in ultrasonography more polypoid lesions of the gallbladder (PLGs) are being detected. The management of these is controversial.
METHODS: The demographic, radiological and pathological data of 38 patients with ultrasonographically detected PLGs were reviewed. A Medline search for such lesions was performed and a review of the literature is presented.
RESULTS: Thirty-four patients underwent cholecystectomy and four were advised against or declined operation. Of the 34 who had cholecystectomy, 11 had macroscopic and histopathologically proven PLGs. Of these, seven had cholesterol polyps, two had adenomas, one had a carcinoid tumour and one had an adenocarcinoma of the gallbladder. One patient had a histopathologically normal gallbladder. The remainder had chronic cholecystitis with or without gallstones. All of the patients with neoplastic lesions of the gallbladder had solitary polyps greater than 1.0 cm in diameter.
CONCLUSION: A protocol for the management of ultrasonographically detected PLGs is proposed. In this protocol it is suggested that patients with a PLG should undergo surgery if they are symptomatic, or if the PLG is 1.0 cm or more in diameter.

PMID 10759734  Br J Surg. 2000 Apr;87(4):414-7. doi: 10.1046/j.1365-21・・・
著者: Xue-Jun Sun, Jing-Sen Shi, Yue Han, Jian-Sheng Wang, Hong Ren
雑誌名: Hepatobiliary Pancreat Dis Int. 2004 Nov;3(4):591-4.
Abstract/Text BACKGROUND: With the wide use of B-ultrasonography in recent years, the polypoid lesion of the gallbladder (PLG) has been one of the most common diseases detected in biliary surgery. This study was to investigate the diagnostic method and operative indications of PLG.
METHODS: The clinical and pathological data of 194 patients with PLG who had received operation at our hospital from January 1994 to September 2002 were analyzed retrospectively. Categorized data were analyzed by the chi-square test.
RESULTS: All the patients received preoperative B-ultrasonography. 185 of the 194 PLG patients were diagnosed as having cholecystic polyp, and 9 adenomas. Among the 42 patients who received CT, 6 showed early gallbladder cancer. Pathologically, cholesterol polyps were mostly multiple lesions (64.7%) with a mean diameter of 3.86+/-2.2 mm in 136 patients. Of 16 patients with adenomas, 10 had a tumor diameter of more than 10 mm (62.5%). In 11 patients with gallbladder carcinoma, 7 were accompanied with gallbladder stone (63.6%). In addition, inflammatory polyps and adenomyomas were found in 25 and 6 patients respectively.
CONCLUSIONS: B-ultrasonography is the most effective diagnostic method for detecting PLG. When large or irregular lesions are found, CT should be performed in order to avoid missing of gallbladder carcinoma. Operative indications for PLG include: a maximal tumor diameter of more than 10 mm; an over 50-year-old patient with a widebase and a single polyp lesion; a wide-base lesion or a lesion showing a tendency to enlargement; co-existing gallbladder stone or cholecystitis; a patient without other diseases but obvious clinical features and failure of general management; big or long pedicels or polyps at the neck of the gallbladder for preventing the empty of the gallbladder and a history of biliary colic; and PLG with irregularly thickened local gallbladder wall.

PMID 15567752  Hepatobiliary Pancreat Dis Int. 2004 Nov;3(4):591-4.
著者: C Terzi, S Sökmen, S Seçkin, L Albayrak, M Uğurlu
雑誌名: Surgery. 2000 Jun;127(6):622-7. doi: 10.1067/msy.2000.105870.
Abstract/Text BACKGROUND: The nature of polypoid lesions of the gallbladder is difficult to define before operation, and surgical indications still remain controversial. The aim of this study was to identify characteristics of each type of polypoid lesion of the gallbladder and indications for surgery.
METHODS: Clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions in 100 patients who had cholecystectomy.
RESULTS: There were 74 benign polypoid lesions, including 39 cholesterol polyps, 20 adenomas, and 15 with adenomyomatous hyperplasia and 26 malignant polypoid lesions. Twenty-seven percent of patients with benign polyps and 73 percent of patients with malignant polyps were over 60 years of age. Polypoid lesions of the gallbladder were diagnosed by preoperative ultrasonography in only 36 patients (36%). All types of polypoid lesions of the gallbladder, whether benign or malignant, were frequently solitary, and gallstones coexisted in the majority of patients with all polypoid lesions of the gallbladder except cholesterol polyps. The lesions were > 10 mm in 88% of the malignant polyps and in only 15% of the benign polyps.
CONCLUSIONS: The risk factors for malignancy were the age of the patient ( >60 years), the coexistence of gallstones, and the size of the polypoid lesions (>10 mm in diameter). In asymptomatic patients, cholecystectomy can be justified if there are risk factors for malignancy.

PMID 10840356  Surgery. 2000 Jun;127(6):622-7. doi: 10.1067/msy.2000.1・・・
著者: Martin D Zielinski, Thomas D Atwell, Peyton W Davis, Michael L Kendrick, Florencia G Que
雑誌名: J Gastrointest Surg. 2009 Jan;13(1):19-25. doi: 10.1007/s11605-008-0725-2. Epub 2008 Oct 30.
Abstract/Text BACKGROUND: Polypoid lesions of the gallbladder (PLG) have been a common finding on ultrasound examinations of the abdomen and are more prevalent since our use of equipment incorporating pulse shaping increased bandwidth, and enhanced phase use for image reconstruction began in 1996. Our study correlates the pre-operative ultrasonographic findings of these lesions to the surgically resected specimen with specific regard to identifying neoplastic polyps.
METHODS: A retrospective review was performed of 130 patients who had a pre-operative ultrasound of the gallbladder and subsequently underwent cholecystectomy between August 1996 and July 2007 at the Mayo Clinic Rochester.
RESULTS: Seventy-nine pseudopolyps (cholesterol polyps, inflammatory polyps, and adenomyomas) and 15 neoplastic polyps were identified on histopathologic analysis. However, 36 patients (27%) did not have a PLG upon histopathologic analysis. Thirty-one polyps had suspicious ultrasonographic characteristics for neoplastic changes. Twenty-nine were > or = 10 mm, 12 had vascularity, and one demonstrated invasion. Of these, there were 23 pseudopolyps and six true polyps with neoplastic changes on final pathology (four dysplastic adenomas and two adenocarcinomas). Three asymptomatic polyps < or = 10 mm (4%) in maximum diameter based on pre-operative ultrasound imaging (US) had neoplastic changes at pathology (two dysplastic adenomas and one adenocarcinoma). Several statistically significant risk factors were identified that increased the likelihood for malignancy in a PLG: history of primary sclerosing cholangitis (PSC), local invasion, vascularity, and > or = 6 mm maximum diameter based on pre-operative US. Of PLGs < or = 10 mm, 7.4% were neoplastic. Twenty-five patients were followed up with at least two serial ultrasound examinations. Of these, seven demonstrated polyp growth. None of these specimens demonstrated neoplastic changes. The positive predictive value (PPV) and negative predictive value (NPV) for ultrasound diagnosing neoplastic changes based on current criteria was 28.5% and 93.1%, respectively, with a false negative rate of 5.0%. Expanding the criteria to include cholecystectomy for PLGs > or = 6 mm changes the positive predictive value and negative predictive value to 18.5% and 100%, respectively, with a false negative rate of 0%.
CONCLUSION: Histopathologic analysis of polypoid lesions of the gallbladder continues to be the gold standard to identify malignancy. Ultrasound has been used extensively in the pre-operative management of these lesions, but modern ultrasound techniques are unable to differentiate between benign and malignant PLGs with any certainty. We recommend that strong consideration be given to surgical resection of PLGs > or = 6 mm based on pre-operative US due to the significant risk of neoplasm. Additionally, PLGs in all patients with PSC, any patient in whom diligent long-term follow-up cannot be completed, and lesions that demonstrate growth, vascularity, invasion, or are symptomatic require cholecystectomy.

PMID 18972168  J Gastrointest Surg. 2009 Jan;13(1):19-25. doi: 10.1007・・・
著者: Graham Donald, Dharma Sunjaya, Timothy Donahue, O Joe Hines
雑誌名: Am Surg. 2013 Oct;79(10):1005-8.
Abstract/Text The association between gallbladder polyps (GBP) and gallbladder cancer (GBC) is unclear. We sought to determine the association between preoperative diagnosis of GBP on imaging and GBC. A retrospective review of patients over 9 years was conducted using International Classification of Diseases, 9th Revision codes for GBP and GBC who underwent cholecystectomy at our institution. Demographics, imaging findings, and pathology results were recorded. A total of 2416 patients underwent cholecystectomy during the study period. Twenty-seven had an operation for GBP either as a result of concern for size or symptoms. Polyp sizes were categorized as less than 1 cm, 1 to 2 cm, or 2 cm or greater. Twenty-four patients in this group (88.9%) had no evidence of high-grade dysplasia or cancer and all of these benign polyps were 2 cm or less on imaging. One patient with a 2.4-cm polyp had high-grade dysplasia, and two patients with polyps over 3 cm had adenocarcinoma. During the same period, 20 patients had an operation for GBC with two patients common to the polyp group. The group of patients with noncancerous polyps was significantly younger than the cancer group (polyps and no polyps). The cancer group was more likely to be symptomatic. Therefore, polyps over 2 cm should be removed given the risk of high-grade dysplasia and cancer above this size. Polyps less than 2 cm were not associated with high-grade dysplasia or cancer and thus surgery may not be required. Intermediate- and small-sized polyps can be monitored with serial ultrasound, especially in younger, asymptomatic patients in whom the risk of malignancy is low.

PMID 24160788  Am Surg. 2013 Oct;79(10):1005-8.
著者: Xue-Song Liu, Tao Chen, Li-Hong Gu, Yi-Fen Guo, Chun-Yang Li, Feng-Hua Li, Jian Wang
雑誌名: J Gastroenterol Hepatol. 2018 Jun;33(6):1295-1299. doi: 10.1111/jgh.14080. Epub 2018 Mar 9.
Abstract/Text BACKGROUND AND AIM: Polypoid lesions of the gallbladder may be neoplastic or non-neoplastic. Correct diagnosis would help reduce unnecessary cholecystectomies. This study aimed to determine the predictive value of individual ultrasound characteristics for diagnosis of neoplastic polyps and to build a scoring system based on these characteristics.
METHODS: A total of 109 patients with gallbladder polyps ≥ 6 mm underwent conventional ultrasound examination and received finally diagnosis by pathological examination. All images were analyzed to determine characteristics of the lesions. Univariate and multivariate analyses were used to identify the predictors of neoplastic polyps, and a scoring system was built based on multivariate analysis.
RESULTS: Maximum diameter, height/width ratio, base width, presence of hyper-echoic spots, and intralesional blood flow were statistically significant (P = 0.011, P = 0.016, P = 0.003, P = 0.031, and P = 0.022, respectively) predictors of neoplastic lesions. The total score = (Maximum diameter, ≥ 13.9 mm = 1, < 13.9 = 0) + (Base width, ≥ 3.5 mm = 1, < 3.4 = 0) + (Height/width ratio, ≤ 1.05 = 1, > 1.05 = 0) + (Hyper-echoic spots, presence = 0, absence = 1) + (Blood flow, presence = 1, absence = 0). Receiver operating characteristic curve showed that the sensitivity, specificity, and accuracy for the risk of neoplastic polyps with scores of 3 or higher were 81.6%, 86.7%, and 84.4%, respectively.
CONCLUSION: This ultrasound-based scoring system could be a useful means for differentiating between neoplastic and non-neoplastic gallbladder polyps in the clinic.

© 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
PMID 29280187  J Gastroenterol Hepatol. 2018 Jun;33(6):1295-1299. doi:・・・
著者: Hiromichi Ito, Lucy E Hann, Michael D'Angelica, Peter Allen, Yuman Fong, Ronald P Dematteo, David S Klimstra, Leslie H Blumgart, William R Jarnagin
雑誌名: J Am Coll Surg. 2009 Apr;208(4):570-5. doi: 10.1016/j.jamcollsurg.2009.01.011.
Abstract/Text BACKGROUND: Polypoid lesions of the gallbladder (PLG) are commonly seen on ultrasonography (US), but optimal management of this problem is ill-defined. The aims of this study were to assess the natural history and the histologic characteristics of US-detected PLG.
STUDY DESIGN: Patients with PLG detected by abdominal US were identified retrospectively. Patients with infiltrative masses suspicious for gallbladder cancer were not included. Histologic findings were analyzed in patients who underwent cholecystectomy, and change in polyp size was determined in patients who underwent serial US imaging.
RESULTS: From 1996 through 2007, 417 patients with PLG detected on US were identified. Two hundred twenty-nine patients (55%) were women, and median age was 59 years (range 20 to 94 years). Two hundred sixty-five patients (64%) were found to have PLG on US during the workup of other unrelated disease; 94 patients (23%) had abdominal symptoms. Ninety-four percent of patients had PLG< or =10 mm, and 7% had PLG>10 mm; 59% of patients had a single polyp and 12% had gallstones. Among 143 patients who had repeat US followup, growth was observed in only 8 patients (6%). Cholecystectomy (n=80) revealed that most patients had either pseudopolyps (58%) or no polyp (32%). Neoplastic polyps (adenoma) were found in 10% of patients. In situ cancer was seen in one patient with a 14-mm lesion.
CONCLUSIONS: Small PLG (< or =10 mm in diameter) detected by US are infrequently associated with symptoms and can be safely observed. The risk of invasive cancer is very low, and was not seen in any patient in this study.

PMID 19476792  J Am Coll Surg. 2009 Apr;208(4):570-5. doi: 10.1016/j.j・・・
著者: K Kubota, Y Bandai, T Noie, Y Ishizaki, M Teruya, M Makuuchi
雑誌名: Surgery. 1995 May;117(5):481-7.
Abstract/Text BACKGROUND: Definitive criteria for choosing the most appropriate treatment for each type of polypoid lesion of the gallbladder (PLG) have yet to be established.
METHODS: The shapes, sizes, echo patterns, and echogenicities of PLGs that had been evaluated by means of ultrasonography in 72 patients who had undergone resective surgery were analyzed retrospectively to elucidate the ultrasonic characteristics of polypoid cancers and to establish criteria for selecting the most suitable treatment such as laparoscopic cholecystectomy for each type of PLG.
RESULTS: Histologic examinations showed cholesterol polyps in 47 patients, adenomas in 8, cancers in 16, and an inflammatory polyp in 1. The diameters of 61% of the benign PLGs were less than 10 mm, whereas those of 88% of the cancers were more than 10 mm; 80% of the former were pedunculated and 56% of the latter were sessile. Seven of eight early-stage cancers had diameters less than 18 mm, whereas those of all eight more advanced cancers were greater than 18 mm. Five of the eight early-stage cancers were pedunculated, and six of the eight more advanced cancers were sessile. Cholecystectomy with or without full-thickness dissection were main surgical procedures used to resect benign PLGs and early-stage cancers, whereas cholecystectomy with partial liver resection was used for more advanced cancers. Laparoscopic cholecystectomy was performed in the recent 34 patients, four of whom had early-stage cancers.
CONCLUSIONS: A PLG with a diameter of less than 18 mm is a potential early-stage cancer and therefore can be resected by laparoscopic cholecystectomy with full-thickness dissection. However, when cancer invades the subserosal layer or beyond, a second-look operation is necessary. A PLG with a diameter of greater than 18 mm may be an advanced cancer and should be removed by using cholecystectomy with partial liver resection or a more extended procedure with lymph node dissection.

PMID 7740417  Surgery. 1995 May;117(5):481-7.
著者: H Moriguchi, J Tazawa, Y Hayashi, H Takenawa, E Nakayama, F Marumo, C Sato
雑誌名: Gut. 1996 Dec;39(6):860-2.
Abstract/Text BACKGROUND: Although polypoid lesions of the gall bladder are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied using ultrasonography.
AIM: The natural history of polypoid lesions of the gall bladder was investigated using ultrasonography.
SUBJECTS: Among 4343 patients who presented to the outpatient clinic of Tsuchiura Kyodo General Hospital in 1988, 111 subjects were diagnosed as having polypoid lesions of the gall bladder by ultrasonography. Among these patients, two had gall bladder carcinoma. The remaining 109 subjects (58 female; age: median 54, range 25-89) were enrolled in this study.
METHODS: The subjects were followed up by ultrasonography once or twice a year until 1994.
RESULTS: Four patients received cholecystectomy and two patients died of other causes during the observation period. In one patient, gall bladder carcinoma was found, but its location was different from that of the pre-existing polyp. The size of the lesions did not change in 88.3% of the other 130 patients during this period, even among those in whom the initial size of the lesion exceeded 10 mm. There was no apparent correlation between the change in the diameter of the polypoid lesions and patients' sex or age.
CONCLUSION: Most polypoid lesions of the gall bladder detected by ultrasonography are benign.

PMID 9038670  Gut. 1996 Dec;39(6):860-2.
著者: Wolfgang Kratzer, Mark M Haenle, Andrea Voegtle, Richard A Mason, Atilla S Akinli, Klaus Hirschbuehl, Andreas Schuler, Volker Kaechele, Roemerstein Study Group
雑誌名: BMC Gastroenterol. 2008 Sep 15;8:41. doi: 10.1186/1471-230X-8-41. Epub 2008 Sep 15.
Abstract/Text BACKGROUND: The management of coincidental detected gallbladder polyps (GP) is still nebulous. There are few published data regarding their long-term growth. Objective of the present study was to investigate the prevalence and growth of gallbladder polyps in a survey of unselected subjects from the general population of a complete rural community.
METHODS: A total of 2,415 subjects (1,261 women; 1,154 men) underwent ultrasound examination of the gallbladder, in November 1996 as part of a prospective study. Subjects in whom GP were detected at the initial survey underwent follow-up ultrasound examinations after 30 and 84 months.
RESULTS: At the initial survey gallbladder polyps were detected in 34 subjects (1.4%; females: 1.1%, range 14 to 74 years; males: 1.7%, range 19 to 63 years). Median diameter was 5 +/- 2.1 mm (range 2 to 10 mm) at the initial survey, 5 mm +/- 2.8 mm (range 2 to 12 mm) at 30 months and 4 +/- 2.3 mm (range 2 to 9 mm) at 84 months. At the time of first follow-up no change in diameter was found in 81.0% (n = 17), reduction in diameter in 4.8% (n = 1) and increase in diameter in 14.3% (n = 3). At the time of second follow-up no increase in polyp diameter was found in 76.9% (n = 10) and reduction in diameter in 7.7% (n = 1). No evidence of malignant disease of the gallbladder was found.
CONCLUSION: Over a period of seven years little change was measured in the diameter of gallbladder polyps. There was no evidence of malignant disease of the gallbladder in any subject.

PMID 18793401  BMC Gastroenterol. 2008 Sep 15;8:41. doi: 10.1186/1471-・・・
著者: H Shinkai, W Kimura, T Muto
雑誌名: Am J Surg. 1998 Feb;175(2):114-7. doi: 10.1016/S0002-9610(97)00262-6.
Abstract/Text BACKGROUND: To determine which polyps of the gallbladder should be operated upon, we investigated the size and number of polyps in resected gallbladders, and studied changes in gallbladder polyps using ultrasonography (US).
METHODS: We studied 74 resected gallbladders with small polypoid lesions less than 20 mm in diameter, and 60 patients with gallbladder polyps by US. The polyps in resected gallbladders were classified into four groups histologically, and clinical features, maximum diameter, and number of lesions were compared among the groups. In the followed-up cases with gallbladder polyps, the size and number of polyps were examined by US, and changes during the observation period were studied.
RESULTS: The mean diameter of adenoma was 6.00 +/- 3.39 mm (mean +/- SD) and that of cancer 10.8 +/- 4.16 mm; 97% of cholesterol polyps were less than 10 mm in diameter (3.66 +/- 2.68 mm). Neoplastic polyps tended to be single (adenoma, n = 1.40 +/- 0.89; cancer, n = 1.16 +/- 0.40), whereas half of the cholesterol polyps were multiple (n = 3.09 +/- 3.31). However, when there were fewer than 3 lesions, the incidence of neoplasm was 37% among polyps 5 to 10 mm in diameter. A low incidence (6%) of neoplasm was also observed among polyps less than 5 mm in diameter.
CONCLUSIONS: These data indicate that an aggressive surgical approach for small gallbladder polyps is warranted when there are fewer than 3 polyps, regardless of their size.

PMID 9515526  Am J Surg. 1998 Feb;175(2):114-7. doi: 10.1016/S0002-96・・・
著者: Jeong Youp Park, Sung Pil Hong, Yoon Jae Kim, Hong Jeoung Kim, Hee Man Kim, Jae Hee Cho, Seung Woo Park, Si Young Song, Jae Bock Chung, Seungmin Bang
雑誌名: J Gastroenterol Hepatol. 2009 Feb;24(2):219-22. doi: 10.1111/j.1440-1746.2008.05689.x. Epub 2008 Nov 26.
Abstract/Text BACKGROUND AND AIM: The management of gallbladder polyps (GBP) is directly linked to the early diagnosis of gallbladder cancer (GBC). This study aimed to evaluate the malignant risk of GBP.
METHODS: In total, 1558 patients diagnosed with GBP were followed. Neoplastic polyps were defined as GBC and its premalignant lesions. The risk for malignancy was estimated with the cumulative detection rate of neoplastic polyps.
RESULTS: Thirty-three cases (2.1%) were diagnosed with neoplastic polyps. The cumulative detection rates of neoplastic polyps were 1.7% at 1 year, 2.8% at 5 years, and 4% at 8 years after diagnosis. The size of GBP and the presence of gallstones were risk factors for neoplastic polyps. Polyps > or = 10 mm had a 24.2 times greater risk of malignancy than polyps < 10 mm. However, 15 of 33 neoplastic polyps (45.5%) were < 10 mm at the time of diagnosis of GBP. During follow up in 36 (3.5%) of 1027 cases, an increase in size was detected; of these, nine (25%) had neoplastic polyps.
CONCLUSION: Even small polyps have a risk of malignancy, and careful long-term follow up of GBP will help detect and treat early GBC.

PMID 19054258  J Gastroenterol Hepatol. 2009 Feb;24(2):219-22. doi: 10・・・
著者: J-H Yoon, S-S Cha, S-S Han, S-J Lee, M-S Kang
雑誌名: Abdom Imaging. 2006 Sep-Oct;31(5):555-63. doi: 10.1007/s00261-005-0230-y.
Abstract/Text In this pictorial essay, we describe the imaging findings of adenomyomatosis of the gallbladder and emphasize high-resolution ultrasound and magnetic resonance cholangiopancreatography in its diagnosis.

PMID 17131208  Abdom Imaging. 2006 Sep-Oct;31(5):555-63. doi: 10.1007/・・・
著者: Mitsuhiro Kida, Rikiya Hasegawa, Takaaki Matsumoto, Takahito Mishima, Toru Kaneko, Shuko Tokunaga, Hiroshi Yamauchi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Miyoko Takezawa, Hidehiko Kikuchi, Maya Watanabe, Hiroshi Imaizumi, Wasaburo Koizumi
雑誌名: Nihon Shokakibyo Gakkai Zasshi. 2015 Mar;112(3):456-63. doi: 10.11405/nisshoshi.112.456.
Abstract/Text
PMID 25759220  Nihon Shokakibyo Gakkai Zasshi. 2015 Mar;112(3):456-63.・・・
著者: T Ootani, Y Shirai, K Tsukada, T Muto
雑誌名: Cancer. 1992 Jun 1;69(11):2647-52.
Abstract/Text Specimens from 3197 consecutive and unselected cholecystectomies performed during a 6-year period were studied. Adenomyomatosis of the gallbladder was defined as a lesion characterized by a thickened wall that consisted of Rokitansky-Aschoff sinuses surrounded by proliferated fibromuscular tissue. Adenomyomatosis was found in 279 specimens and classified as one of three types: segmental, fundal, or diffuse. Segmental adenomyomatosis was found in 188 specimens; gallbladder cancer (GBC) developed in 12 (6.4%) of the patients with segmental type adenomyomatosis. GBC developed in the mucosa of the fundal compartment distal to the annular stricture of the segmental type adenomyomatosis in all 12 of these patients. Conversely, GBC developed in 93 (3.1%) of the other 3009 patients (those with fundal alone, diffuse, or no adenomyomatosis). The prevalence of GBC in patients with segmental adenomyomatosis was significantly (P less than 0.025) higher than that of patients without segmental adenomyomatosis. Clinicians should be aware that segmental adenomyomatosis often coexists with GBC.

PMID 1571894  Cancer. 1992 Jun 1;69(11):2647-52.

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