Although ultrasound has improved gallbladder polyp identification, it is still limited in its ability to evaluate the polyps’ nature, particularly beyond a size of about 1.5 centimeters. Therefore, to differentiate between adenomatous polyps and cholesterol polyps, researchers tested the efficacy of an ultrasonic scoring system based on independent predictive indicators with a cutoff size of 1.0 to 1.5 cm. 

They enrolled 163 individuals who had had ultrasonography and cholecystectomy for gallbladder polyps (1.0 to 1.5 cm). From April 2018 through January 2020, ultrasound images of cholesterol polyps and adenomatous polyps in the training cohort were compared. From February 2020 – February 2021, the diagnostic performance of an ultrasound scoring system developed in a training cohort was assessed in a separate cohort. 

In the training cohort, there were statistically significant differences between cholesterol polyps and adenomatous polyps in maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot (P<0.05). A reduced height-to-width ratio, the presence of vascularity, and the absence of a hyperechoic area were found to be the most significant independent prognostic criteria for adenomatous polyps. The final score was made up of the following factors: height-to-width ratio (<0.9=4, ≥0.9=0) + vascularity (present = 3, absent = 0) + hyperechoic spot (present = 2, absent = 0). Ultrasound scoring systems more than or equal to 5 for the diagnosis of adenomatous polyps had a sensitivity of 73.33%, a specificity of 80.49%, and an accuracy of 78.57% in the validation cohort. 

The ultrasound scoring system can differentiate between adenomatous polyps and cholesterol polyps, which can lead to a reduction in the number of cases where a cholecystectomy is performed when necessary.