Polypoid lesions of the gallbladder (PLG) is a general term for all non-lithotropic lesions in which the wall of the gallbladder grows as a polyp into the lumen. With the widespread use of abdominal ultrasound, PLG has become a more common lesion in routine ultrasound examinations. The incidence of polypoid lesions in the gallbladder ranges from approximately 1% to 9%. Currently, polypoid lesions of the gallbladder are generally classified into non-neoplastic and neoplastic lesions, with gallbladder adenoma and gallbladder cancer being neoplastic lesions and the rest being non-neoplastic lesions. Non-neoplastic lesions include cholesterol polyps, adenomyosis of the gallbladder, inflammatory polyps, fibrous polyps, and mixed polyps. Neoplastic polyps must be treated surgically. Although most gallbladder polypoid lesions are benign, it is difficult to distinguish between neoplastic and non-neoplastic polyps during routine ultrasonography, so it is important to identify neoplastic and non-neoplastic polyps before surgery. Size is the most valuable parameter to predict the benignity and malignancy of gallbladder polyp-like lesions. Gallbladder polypoid lesions larger than 10 mm are currently the most widely accepted indication for surgery. In this study, 18.6% of all gallbladder polypoid lesions larger than 10 mm were neoplastic polyps, while only 3.3% of PLGs smaller than 10 mm were neoplastic polyps. Since gallbladder cancer below 10 mm is generally confined, there is no greater risk of cholecystectomy after it reaches 10 mm in diameter under close follow-up. Age is another important parameter to predict the benignity of gallbladder polyp-like lesions. Most of the current findings tend to consider older than 50 years as an indication for surgery of gallbladder polypoid lesions. In the present study, 9.2% of the cases younger than 50 years were neoplastic polyps, while 14.6% of the cases older than 50 years were neoplastic polyps. Therefore, it is still appropriate to use 50 years of age as a cut-off point for benign and malignant lesions. In patients with abdominal symptoms, although they are mostly non-neoplastic polyps, cholecystectomy can be performed for symptom relief. Although there was no clear association between whether the patients in this study were combined with gallbladder stones and whether the gallbladder polyp-like lesions were tumor polyps or not, it is generally believed that if tumor polyps are combined with gallbladder stones there will be an accelerated possibility of malignant transformation of tumor polyps. Gender, total cholesterol, triglycerides, HDL, and LDL were not significantly different between the tumor polyp group and the non-tumor lesion group. In other words, there was no significant guideline of these indicators for whether to operate or not. In conclusion, gallbladder polyp-like lesions are more common in abdominal ultrasonography, and we recommend surgery for patients with abdominal symptoms, polyps ≥10 mm in diameter, age ≥50 years and combined with gallbladder stones. The rest of PLG patients need long-term follow-up and surgery is recommended when they are more than 10 mm in diameter or when they become symptomatic.