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Ultrasound for the Detection of Gallbladder Malignancy in Primary Sclerosing Cholangitis

Altenmüller, Johannes ; Wiegard, Christiane ; Sebode, Marcial ; Lohse, Ansgar W. ; Villard, Christina ; Kechagias, Stergios ; Nilsson, Emma LU ; Rorsman, Fredrik ; Marschall, Hanns Ulrich and Jokelainen, Kalle , et al. (2025) In Liver International 45(9).
Abstract

Background and Aims: In primary sclerosing cholangitis (PSC), the risk for gallbladder malignancy is increased. Surveillance imaging is used for early diagnosis. The study aims to assess the reliability of ultrasound and magnetic resonance imaging (MRI) for the detection of gallbladder polyps in people with PSC and to define a polyp size as a cut-off at which cholecystectomy is indicated due to the high probability of a malignant finding. Methods: In this retrospective European multicentre study, we included 51 people with PSC who had cholecystectomy for gallbladder polyps detected on imaging using ultrasound and/or MRI within 6 months prior to cholecystectomy and a histology report available. As a control group, we included 102 people... (More)

Background and Aims: In primary sclerosing cholangitis (PSC), the risk for gallbladder malignancy is increased. Surveillance imaging is used for early diagnosis. The study aims to assess the reliability of ultrasound and magnetic resonance imaging (MRI) for the detection of gallbladder polyps in people with PSC and to define a polyp size as a cut-off at which cholecystectomy is indicated due to the high probability of a malignant finding. Methods: In this retrospective European multicentre study, we included 51 people with PSC who had cholecystectomy for gallbladder polyps detected on imaging using ultrasound and/or MRI within 6 months prior to cholecystectomy and a histology report available. As a control group, we included 102 people with PSC with other indications for cholecystectomy. Malignancy was defined as high-grade dysplasia or carcinoma on histology. Results: Including all 153 patients, ultrasound was significantly more sensitive than MRI in detecting gallbladder polyps (p < 0.001). MRI missed 3 of the 8 malignant polyps. Malignant polyps (n = 8, median size = 12.5 mm) were significantly larger than non-malignant polyps (n = 26, median size = 6 mm) on ultrasound (p < 0.001). Ultrasound detected malignant polyps reliably (AUC = 0.91, p < 0.001) with an optimal cut-off of 8 mm. This cut-off was defined in the Hamburg cohort and validated in a multicentre validation cohort with an AUC of 0.92 (p = 0.02). Conclusions: Ultrasound is more sensitive for the detection of gallbladder polyps than MRI in people with PSC. The best cut-off to differentiate between benign and malignant polyps was 8 mm. Ultrasound (gallbladder) and MRI (bile ducts) may thus be complementary methods for hepatobiliary malignancy surveillance in people with PSC.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cholecystectomy, imaging, malignancy, PSC
in
Liver International
volume
45
issue
9
article number
e70312
publisher
Wiley-Blackwell
external identifiers
  • scopus:105014603095
  • pmid:40856347
ISSN
1478-3223
DOI
10.1111/liv.70312
language
English
LU publication?
yes
id
5ac634f5-cd77-4a29-a36f-22e7c14283b1
date added to LUP
2025-10-16 13:30:19
date last changed
2025-10-17 03:00:10
@article{5ac634f5-cd77-4a29-a36f-22e7c14283b1,
  abstract     = {{<p>Background and Aims: In primary sclerosing cholangitis (PSC), the risk for gallbladder malignancy is increased. Surveillance imaging is used for early diagnosis. The study aims to assess the reliability of ultrasound and magnetic resonance imaging (MRI) for the detection of gallbladder polyps in people with PSC and to define a polyp size as a cut-off at which cholecystectomy is indicated due to the high probability of a malignant finding. Methods: In this retrospective European multicentre study, we included 51 people with PSC who had cholecystectomy for gallbladder polyps detected on imaging using ultrasound and/or MRI within 6 months prior to cholecystectomy and a histology report available. As a control group, we included 102 people with PSC with other indications for cholecystectomy. Malignancy was defined as high-grade dysplasia or carcinoma on histology. Results: Including all 153 patients, ultrasound was significantly more sensitive than MRI in detecting gallbladder polyps (p &lt; 0.001). MRI missed 3 of the 8 malignant polyps. Malignant polyps (n = 8, median size = 12.5 mm) were significantly larger than non-malignant polyps (n = 26, median size = 6 mm) on ultrasound (p &lt; 0.001). Ultrasound detected malignant polyps reliably (AUC = 0.91, p &lt; 0.001) with an optimal cut-off of 8 mm. This cut-off was defined in the Hamburg cohort and validated in a multicentre validation cohort with an AUC of 0.92 (p = 0.02). Conclusions: Ultrasound is more sensitive for the detection of gallbladder polyps than MRI in people with PSC. The best cut-off to differentiate between benign and malignant polyps was 8 mm. Ultrasound (gallbladder) and MRI (bile ducts) may thus be complementary methods for hepatobiliary malignancy surveillance in people with PSC.</p>}},
  author       = {{Altenmüller, Johannes and Wiegard, Christiane and Sebode, Marcial and Lohse, Ansgar W. and Villard, Christina and Kechagias, Stergios and Nilsson, Emma and Rorsman, Fredrik and Marschall, Hanns Ulrich and Jokelainen, Kalle and Bergquist, Annika and Färkkilä, Martti and Schramm, Christoph}},
  issn         = {{1478-3223}},
  keywords     = {{cholecystectomy; imaging; malignancy; PSC}},
  language     = {{eng}},
  number       = {{9}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Liver International}},
  title        = {{Ultrasound for the Detection of Gallbladder Malignancy in Primary Sclerosing Cholangitis}},
  url          = {{http://dx.doi.org/10.1111/liv.70312}},
  doi          = {{10.1111/liv.70312}},
  volume       = {{45}},
  year         = {{2025}},
}