基于超声的多级评分系统用于区分胆囊腺瘤性息肉和非肿瘤性息肉

IF 1.9 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology Pub Date : 2025-07-16 DOI:10.1016/j.crad.2025.107024

L. Jiang , M. Xu , J. Yao, Z. Yang, X. Zhang, W. Wu, H. Guo, X. Xie, X. Xie, T. Huang

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引用次数: 0

摘要

目的建立基于常规超声（US）和临床特征的多层次评分系统，以区分大小≥1.0 cm的胆囊腺瘤和非肿瘤性息肉，以降低胆囊不必要切除率（UNRR）。材料与方法回顾性分析我院2011年1月至2022年1月因胆囊息肉≥1.0 cm行胆囊切除术的患者。根据病理情况将患者分为腺瘤性息肉组和非肿瘤性息肉组。采用logistic回归筛选危险因素，构建多层次评分体系。与现行指南比较，采用敏感性、特异性、阳性预测值、阴性预测值和UNRR评价模型。结果223例患者（年龄18-72岁，女性占59.2%），其中腺瘤性息肉组48例，非肿瘤性息肉组175例。美国评分系统将息肉大小、息肉形态比例和胆结石缺失作为腺瘤的危险因素。临床-美国评分系统包括天冬氨酸转氨酶（AST）、总胆汁酸（TBA）、息肉大小、均匀回声和胆结石。美国临床评分系统比美国评分系统具有更好的辨别性。当临床-美国评分系统2-4级的患者推荐胆囊切除术时，非肿瘤性息肉的UNRR与现行指南相比显著降低（83.4% vs 100.0%, P<0.001），同时保持相当的敏感性（0.979 vs 1.000, P>0.999）。结论基于临床和常规超声特征的多级评分系统可有效区分胆囊腺瘤性息肉和≥1.0 cm的非肿瘤性息肉。

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Multilevel scoring systems based on ultrasound for differentiating between gallbladder adenomatous polyps and non-neoplastic polyps

AIM

The aim of this study was to develop multilevel scoring systems based on conventional ultrasound (US) and clinical characteristics to distinguish gallbladder adenoma and non-neoplastic polyps ≥1.0 cm in size in order to reduce the gallbladder unnecessary resection rate (UNRR).

MATERIALS AND METHODS

Retrospective analysis was conducted on patients who underwent cholecystectomy for gallbladder polyps measuring ≥1.0 cm at a hospital from January 2011 to January 2022. According to pathology, the patients were divided into adenomatous polyp group and non-neoplastic polyp group. The risk factors were selected by logistic regression, and multilevel scoring systems were constructed. Compared with the current guidelines, sensitivity, specificity, positive predictive value, negative predictive value, and UNRR were used to evaluate the model.

RESULTS

The study included 223 patients (aged 18–72 years, 59.2% female), with 48 patients in the adenomatous polyp group and 175 in the non-neoplastic polyp group. The US scoring system considered polyp size, polyp morphology ratio, and the absence of gallstones as risk factors for adenoma. The clinical-US scoring system consisted of aspartate aminotransferase (AST), total bile acid (TBA), polyp size, homogeneous echogenicity, and gallstones. The clinical US scoring system has better discrimination than the US scoring system. When cholecystectomy was recommended for patients in grade 2–4 of the clinical-US scoring system, the UNRR of non-neoplastic polyps was significantly reduced compared to current guidelines (83.4% vs 100.0%, P<0.001), while maintaining comparable sensitivity (0.979 vs 1.000, P>0.999).

CONCLUSION

The multilevel scoring systems based on clinical and conventional US features can effectively differentiate between gallbladder adenomatous polyps and non-neoplastic polyps ≥1.0 cm in size.

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来源期刊

Clinical radiology 医学-核医学

CiteScore

4.70

自引率

3.80%

发文量

528

审稿时长

76 days

期刊介绍： Clinical Radiology is published by Elsevier on behalf of The Royal College of Radiologists. Clinical Radiology is an International Journal bringing you original research, editorials and review articles on all aspects of diagnostic imaging, including: • Computed tomography • Magnetic resonance imaging • Ultrasonography • Digital radiology • Interventional radiology • Radiography • Nuclear medicine Papers on radiological protection, quality assurance, audit in radiology and matters relating to radiological training and education are also included. In addition, each issue contains correspondence, book reviews and notices of forthcoming events.