Gallbladder polypoid lesions are inaccurately reported and undermanaged: a retrospective study of the management of gallbladder polypoid lesions detected at ultrasound in symptomatic patients during a 36-month period

• Published in: Clinical radiology Vol. 74; no. 6; pp. 489.e17 - 489.e23
• Main Authors: Abdullah, A.A.N., Rangaraj, A., Rashid, M., Puw-Jones, R., Rasheed, A.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2019
• Subjects: Diagnostic Errors - statistics & numerical data; Female; Gallbladder - diagnostic imaging; Gallbladder Neoplasms - diagnostic imaging; Humans; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Treatment Outcome; Ultrasonography - methods
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2019.02.009

To investigate whether gallbladder polypoid lesions (GPL) are accurately reported and managed by radiologists, sonographers, general practitioners (GPs) and surgeons. Consecutive abdominal ultrasound examinations indicating GPL in symptomatic patients performed during 2011–2013 were captured and analysed. The study comprised 244 patients who satisfied the inclusion criteria. Of the ultrasound reports retrieved, 238/244 reports (98%) erroneously described the polypoid lesions as polyps. One hundred and thirty-two of the 244 (54%) reports recommended follow-up, 5/244 (2%) recommended no follow-up, 35/244 (14%) deemed the findings insignificant, and 72/244 (30%) did not comment. Regarding GP referral, 57/184 (31%) patients were correctly referred to general surgeons, 20/184 (11%) to gastroenterologists, and 107/184 (58%) were not referred to secondary care. Forty-three of the 244 patients (18%) underwent cholecystectomy. Regarding subsequent biliary presentations, 63/244 patients (26%) presented at a later date with biliary symptoms; 13/63 (21%) of these eventually had cholecystectomies with 2/13 (15%) experiencing potentially life-threatening pancreatitis episodes. Regarding the surgical approach, differences were observed in the way individual surgeons managed polypoid lesions, with some veering towards cholecystectomy, others towards follow-up ultrasound, and some towards discharge. GPL tend to be misreported by radiologists and sonographers, unappreciated by GPs, and variably managed by surgeons. These factors delay definitive therapy and seem to contribute to future biliary presentations. A fresh educational approach is required to raise awareness among radiologists, sonographers, and GPs regarding the clinical relevance and possible representations of GPL, and a uniform strategy is needed for managing GPL. •Gallbladder polypoid lesions (GPL) tend to be misreported by radiologists and sonographers as ‘polyps’.•GPL are subsequently unappreciated by GPs who lean towards discharging these patients.•26% of our patients thus re-presented in the future with the same symptoms.•Even with surgical referral there is variable management amongst surgeons.•A fresh educational approach is required to raise awareness regarding possible representations of GPL.