Which feature of a gallbladder polyp on ultrasound most reliably predicts malignancy and mandates cholecystectomy regardless of size?

• A Solitary sessile polyp of 5 mm
• B Multiple polypoid lesions less than 5 mm
• C Polyp associated with gallbladder adenomyomatosis
• D Polyp with demonstrable vascularity on Doppler or growth on serial imaging ✓

Explanation

The two features that most reliably predict malignancy — independent of absolute size — are: (1) demonstrable internal vascularity on Doppler (indicating true neoplastic growth rather than cholesterol polyp), and (2) interval growth on serial imaging. European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guidelines recommend cholecystectomy for any polyp showing growth on follow-up regardless of size. Multiple small polypoid lesions <5 mm are nearly always cholesterol polyps (pseudopolyps) with negligible malignant potential. Adenomyomatosis is a benign degenerative condition not requiring surgery unless symptoms persist.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.