Abstracts
1999 Digestive Disease Week

# 2070 THE INACCURACY OF ULTRASONOGRAPHY IN DIAGNOSING POLYPOID LESIONS OF THE GALLBLADDER
Lawrence J Damore II, K Fernandez, C H Cook, J Cunningham, W S Melvin, E C Ellison, Ohio State Univ Med Ctr, Columbus, OH

Background: Polypoid lesions of the gallbladder (PLG) are diagnosed with ultrasound when "non-shadowing," fixed, solid masses are found projecting from the gallbladder mucosa into the lumen. The accuracy of ultrasound for this diagnosis is controversial because previous studies have reported sensitivities that range from 38-90%. Our objective was to determine the accuracy of ultrasonography in diagnosing PLG.
Methods: A retrospective review of all patients diagnosed with gallbladder polyps by ultrasonography from 1988 to 1995 was conducted. The medical records of patients diagnosed with polyps who underwent cholecystectomy were reviewed and data concerning age, sex, symptomatology, and histopathologic diagnosis was collected.
Results: Forty-one of 322 patients diagnosed with gallbladder polyps on ultrasonography had cholecystectomy. Mean patient age was 47.4 years and symptoms occurring at presentation were pain (85%), nausea (44%), vomiting (29%), and abnormal liver function tests (14%). Histopathologic evaluation confirmed only two (4.9%) patients had findings that could be categorized as PLG. One of the specimens contained an adenomyoma and the other had multiple cholesterol polyps. Many specimens with ultrasound reports revealing "small polyps" manifested cholesterolosis (16/39) or cholelithiasis (15/39) on examination by the pathologist. No specimen harbored malignancy.,
Conclusions: Sonography detected abnormalities within the gallbladders in all but two patients. However, the accuracy of sonography for diagnosing PLG was poor. Many of the "small polyps" seen with sonography represented a stone embedded in the gallbladder wall. We recommend that patients with biliary symptoms and ultrasound findings of PLG should undergo cholecystectomy given their likelihood of cholelithiasis. In addition, we suggest limiting the radiological report to a description of the findings rather than a "histologic" diagnosis.

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