A Retrospective Study Of The Clinicopathological Features Of Polypoid Lesions Of The Gallbladder

Objective:To identify risk factors of neoplastic and malignant polypoid lesions of gallbladder (PLG).Methods:Data from329patients with PLG who were undergone laparoscopic cholecystectomy in our department from December in2011to December in2014were reviewed retrospectively. Patients were classified into different groups according to the idea proposed by Christensen and Ishak and the pathologic results of resected gallbladders. Clinical features including age, sex, symptom, number and size of PLG and pathological results of the resected gallbladders were compared and analyzed among different groups including non-neoplastic and neoplastic, benign and malignant polyps groups. Univariate analysis and multivariate logistic regression analysis were used to identify risk factors related to neoplastic and malignant polyps. And receiver operating characteristic curve (ROC curve) were drawed for continuous variables to obtain the cut-off value and predict effectiveness of the risk factors.Results:It is difficult to differentiate non-neoplastic and neoplastic or benign and malignant polyps by solely imaging tests. Basic situation of these patients were like this, the youngest patient was19years old, while the oldest was77years old, and the mean age was45.5±12.3years. There were135(41%) men and194(59%) women, and89 (27%) patients were symptomatic, while240(73%) were asymptomatic. And there were147(45%) patients with single polyps and182(55%) with multiple polyps. And their mean size was1.19±0.37cm. Among them,277(84.2%) were non-neoplastic polyps,43(13.1%) were adenoma, and9(2.7%) were malignant polyps. Univariate analysis showed that among329patients with PLG, neoplastic polyps group were more with single polyps (p=0.001) and larger polyps (p=0.032) than the non-neoplastic polyps group. Malignant polyps groups were more with single polyps(p=0.002) and larger polyps(p<0.001) and older (p=0.007) and more with symptom (p=0.02) than the benign polyps group. While multivariate logistic regression analysis showed that number (single, p=0.014) and size (larger than1cm, p<0.001) of PLQ and age of the patients(older than50, p=0.008) were independent factors to predict neoplasm, and size (larger than1.5cm, p=0.011) of PLG and age of the patients(older than50, p=0.004) were independent factors to predict malignancy in PLG And ROC curve showed that it were not very accurate to predict neoplasm just by age or size while it could predict malignancy through age and size on some level and the cut-off value of age and size were48.5and1.515. While the cut-off values were rounded off to50and1.5for convenience in clinical application.Conclusion:Neoplastic lesions should be considered when a patient older than50has a single polypoid lesion larger than1cm. While malignant lesions should be alerted when a patient older than50has a polypoid lesion larger than1.5cm.