115 Pre Operative Imaging vs Post Operative Histopathology of Gallbladder Polyps

Abstract Aim To evaluate the reliability and accuracy of ultrasound in the assessment of gallbladder polyps. Method A retrospective review of patients diagnosed with gallbladder polyps who had cholecystectomy between January 2020 and December 2024. Data collection included the diagnostic modality, size of the polyp on imaging, the histological diagnosis and the polyp size on histology. Results 88 patients were identified from 1022 reviewed.60 females (2.2:1 Female to Male ratio) and median age 45. Ultrasound was performed in 86 patients (97.7%) with the mean ultrasound reported polyp size of 9.7mm (1.2-22). Mean histological polyp size was 4.6mm (2-15), with a difference of 5.1mm (p < 0.001). Polyps were confirmed on histopathology in 48 patients (54.5%), 27 of them were symptomatic, giving a positive predictive value (PPV) of 53.9% for ultrasound. Reviewing the histology, 36 patients had ≥10 mm polyps at ultrasound, but 10 (27%) of these had no polyps on histology. Of the whole cohort 8 (9%) had concomitant gallstones 23 (26.1%) had gallstones but no polyps, and 14 (15.9%) had chronic cholecystitis with no polyps or gallstones. One patient (1.1%) had an adenocarcinoma confirmed at histology. The median interval between last imaging and surgery was 26.6 weeks. Conclusions Ultrasound is the principal modality for diagnosing gallbladder polyps; however, it is of limited diagnostic accuracy. These results advocate for a cautious approach towards surgery in this setting, particularly when considering the 10 mm cut off point as the main indication.