Follow-up imaging and surgical costs associated with different guidelines for management of incidentally detected gallbladder polyps

Jenny M Vo-Phamhi; Thodsawit Tiyarattanachai; Martin Matuszczak; Luyao Shen; Solomon Kim; Aya Kamaya

doi:10.1016/j.acra.2024.05.034

Follow-up imaging and surgical costs associated with different guidelines for management of incidentally detected gallbladder polyps

Acad Radiol. 2024 Jun 10:S1076-6332(24)00337-4. doi: 10.1016/j.acra.2024.05.034. Online ahead of print.

Authors

Jenny M Vo-Phamhi¹, Thodsawit Tiyarattanachai², Martin Matuszczak³, Luyao Shen⁴, Solomon Kim⁵, Aya Kamaya⁶

Affiliations

¹ Columbia University Vagelos College of Physicians & Surgeons, 630 W 168th St, New York, NY 10032. Electronic address: jmv2197@cumc.columbia.edu.
² Department of Radiology and Department of Biomedical Data Science, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305. Electronic address: ttiya@stanford.edu.
³ Stanford Hospital and Clinics, 300 Pasteur Dr H1307, Stanford, CA 94305. Electronic address: matu@stanford.edu.
⁴ Stanford Hospital and Clinics, 300 Pasteur Dr H1307, Stanford, CA 94305. Electronic address: lyshen@stanford.edu.
⁵ Integrated Imaging Consultants, LLC, 4440 West 95th Street, Department of Radiology, Oak Lawn, IL 60453. Electronic address: kimgunh93@gmail.com.
⁶ Stanford Hospital and Clinics, 300 Pasteur Dr H1307, Stanford, CA 94305. Electronic address: kamaya@stanford.edu.

PMID: 38862347
DOI: 10.1016/j.acra.2024.05.034

Abstract

Rationale and objectives: To compare follow-up imaging and surgical cost implications of the Society of Radiologists in Ultrasound (SRU) guidelines, 2017 and 2022 European (EUR) guidelines, 2020 Canadian Association of Radiologists (CAR) recommendations, and 2013 American College of Radiology (ACR) White Paper for managing incidentally detected gallbladder polyps.

Materials and methods: 253 consecutive patients with gallbladder polyps identified on ultrasound were independently reviewed by three radiologists for polyp size and morphology. Electronic medical records were reviewed for patient demographics, cholecystectomy (if performed) pathological findings, or any subsequent diagnosis of gallbladder cancer. For each patient, the following were calculated for each of the 5 guidelines studied: 1) number of recommended follow-up ultrasounds based on initial presentation, 2) number of surgical consultations recommended based on initial presentation, 3) number of surgical consultations recommended based on growth, and 4) associated imaging and surgical costs. Interrater agreement was calculated.

Results: The SRU 2022 guidelines suggested significantly fewer follow-up ultrasounds and surgical consultations, leading to a cost reduction of 96.5 % and 96.7 % compared to European 2022 and 2017, respectively; 86.5 % compared to CAR; and 86.2 % compared to ACR guidelines. With SRU Recommendations, the majority of gallbladder polyps would be classified as extremely low risk (68.4 %), 30.8 % low risk, and 0.8 % indeterminate risk. In our cohort, a single case of gallbladder cancer was identified (26 mm) which would be recommended for surgical consult by all guidelines.

Conclusion: The SRU 2022 guidelines can lead to significant savings for patients, health systems, and society, while reducing unnecessary medical interventions for managing incidentally detected gallbladder polyps.

Keywords: Gallbladder cancer; Gallbladder polyp; Polypoid lesion of gallbladder; SRU Consensus Conference.