Several other reports support the importance of polyp size in differentiating benign from malignant lesions. Koga et al reported a retrospective study of 411 patients who had undergone cholecystectomy; 32 patients had benign polyps and eight patients had malignancies. In that study, 94% of the benign PLG were less than 10 mm in diameter, whereas 88% of the cancers exceeded this diameter. Similarly, in 72 patients who had undergone resective surgery for PLG, Kubota and colleagues reported that 61% of benign lesions were less than 10 mm in diameter compared with only 12% of cancers. The size of carcinomatous PLG also appears to correlate with the extent of tumour invasion.
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Several other features have emerged as important discriminators in the diagnosis of malignant gallbladder polyps, including patient age. In the study by Koga et al, 69% of those with benign lesions were under 60 years of age, whereas 75% with malignancies were over 60 years of age. Similarly, Terzi and colleagues reported that only 27% of patients with benign PLG versus 73% of patients with malignant PLG were over 60 years of age. Yang et al, using a lower age cutoff, reported malignant PLG in 21% of 56 patients over 50 years of age, whereas benign lesions were found in 115 of 116 patients (99%) under 50 years of age. Others have reported an increased risk of malignancy in PLG that are sessile, associated with wall thickening, rapidly growing, and/or associated with gallstones.