Ultrasound scoring system differentiates adenomatous from cholesterol polyps

A conventional ultrasound (US)-based scoring system reliably distinguishes adenomatous polyps from cholesterol polyps and reduces the need for cholecystectomy, a study has shown.

The authors evaluated the value of US scoring system based on independent predictive parameters in differentiating adenomatous from cholesterol polyps with a maximum size of 1.0 to 1.5 cm. A total of 163 patients with gallbladder polyps who underwent ultrasonography and cholecystectomy were enrolled in this study.

In a training cohort, ultrasound image characteristics were compared between cholesterol and adenomatous polyps from April 2018 to January 2020. The authors constructed a US scoring system in this cohort and assessed its diagnostic performance in a validation cohort from February 2020 to February 2021.

The following characteristics were significantly different between cholesterol and adenomatous polyps in the training cohort: maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot (p<0.05).

Lower height/width ratio, presence of vascularity, and absence of hyperechoic spot were independently associated with adenomatous polyps. The total score was as follows: height/width ratio (<0.9=4, ≥0.9=0) + vascularity (present=3, absent=0) + hyperechoic spot (present=0, absent=2).

The sensitivity, specificity, and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33 percent, 80.49 percent, and 78.57 percent, respectively.

“Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm,” the authors said.