Histopathological Characteristics and Risk Factors of Gallbladder Polyps with Malignant Potential

Background: Gallbladder polyps (GBPs) are commonly detected lesions that are predominantly benign; however, some carry a risk of premalignant or malignant transformation. Accurate identification of high-risk polyps is essential for appropriate clinical management.Methods: A retrospective analysis was conducted on patients who underwent elective cholecystectomy between March 2015 and March 2026 at the our center. Patients with GBPs confirmed by postoperative histopathological examination were included. Demographic data, laboratory parameters, polyp characteristics, gallbladder wall thickness, and histopathological findings were analyzed. Statistical analyses included one-way analysis of variance, Kruskal–Wallis test, chi-square or Fisher’s exact test, and receiver operating characteristic (ROC) curve analysis.Results: A total of 103 patients were included. Histopathological examination revealed adenocarcinoma in 4 patients (3.9%), adenoma in 5 (4.9%), hyperplastic polyps in 8 (7.8%), inflammatory polyps in 6 (5.8%), and cholesterol polyps in 80 patients (77.7%). Polyp size, age, gallbladder wall thickness, and serum CA 19-9 levels were significantly higher in malignant cases. ROC analysis showed that polyp size (AUC = 0.97) and age (AUC = 0.93) had excellent diagnostic performance for predicting malignancy.Conclusion: Polyp size remains the most reliable predictor of malignancy in gallbladder polyps. Advanced age, increased gallbladder wall thickness, and elevated CA 19-9 levels are additional risk factors that should be considered in clinical decision-making.