Hidden signals in the gallbladder: a clinicopathological deep dive into 148 polyps among 11,108 surgeries.

BACKGROUND/AIM: Gallbladder polyps (GBPs) are increasingly detected during imaging and often identified incidentally in cholecystectomy specimens. However, management strategies vary, particularly for small, asymptomatic polyps. This study aimed to determine the prevalence, types, and malignant potential of GBPs through pathological examination of cholecystectomy specimens. METHODS: We retrospectively reviewed 11,108 cholecystectomies performed from January 2014 to January 2024. Histopathologically confirmed GBPs were identified in 148 patients. Data on demographics, comorbidities, imaging, surgical approach, and polyp features were analyzed. RESULTS: Of 148 patients with GBPs, 77% were female and the median age was 48 years. Hypertension (31.8%) and diabetes (16.9%) were common comorbidities. Preoperative ultrasonography detected polyps in only 33.8% of cases. Most polyps (81.8%) were pedunculated and ≤ 10 mm. Cholesterol polyps accounted for 64.2%, and precancerous/malignant lesions for 19.6%. Multivariable analysis showed sessile morphology (OR: 4.2, p = 0.001) and size ≥ 10 mm (OR: 3.8, p = 0.004) were significantly associated with malignancy. CONCLUSION: While most GBPs are benign, a significant proportion carry malignant potential, particularly sessile polyps ≥ 10 mm. Improved risk stratification based on morphology and size is essential to guide management. Development of standardized follow-up protocols and refinement of imaging criteria are warranted.