Is there any justification for the routine histological examination of straightforward cholecystectomy specimens?

Selective histopathology in cholecystectomy for gallstone disease

BACKGROUND

Incidental gallbladder cancer is found in upto 1% of cholecystectomy specimens for gallstone disease. Currently, in our institution, all gallbladder specimens are sent for routine histopathology, to rule out incidental gallbladder carcinoma. This study was aimed at assessing the need for routine histopathology of gallbladder specimens after cholecystectomy for gallstone disease.

METHODS

Hospital records of all patients undergoing cholecystectomy for gallstone disease over a ten-year period, between 1998 and 2007, in a single surgical unit were reviewed.

RESULTS

A total of 1312 patients underwent cholecystectomy for gallstone disease. Gallbladder carcinoma was detected in 13 patients. Macroscopic abnormalities of the gallbladder were found in all the 13 patients. In patients with a macroscopically normal gallbladder, there were no cases of gallbladder carcinoma.

CONCLUSION

Gallbladder carcinoma is associated with macroscopic abnormalities in all cases. Therefore histopathology should be restricted to only those specimens which reveal a macroscopic abnormality. This would identify all cases of incidental gallbladder carcinoma, at the same time decreasing cost and pathological work load.

Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid

BACKGROUND

The purpose of this study was to assess the need for a routine histopathologic examination of three common surgical specimens (appendix, gallbladder, hemorrhoid) and its impact on the further management of the patients.

METHODS

Histopathologic reports of patients undergoing appendectomy, cholecystectomy, or hemorrhoidectomy performed between 1998 and 2006 in the Faculty of Medicine, Siriraj Hospital were reviewed. The reports were excluded if patients had a clinical diagnosis or suspicion of malignancy. The incidence of unexpected pathologic diagnoses and their impact on postoperative management were evaluated.

RESULTS

Of 4545 appendectomy specimens, 44 (0.97%) revealed incidental unexpected pathological diagnoses, including one adenocarcinoma and one primary appendiceal lymphoma. About one-fifth of such unexpected appendiceal findings had an impact on postoperative treatment. Unexpected pathologic gallbladder findings were found in 88 (2%) of 4317 cholecystectomy specimens. Gallbladder cancer (GBC) was detected in 24 specimens (0.56%). A clinical diagnosis of empyema and patient's age over 60 years were two significant risk factors for an unexpected GBC [odds ratio (OR) 11.0, 95% confidence interval (CI) 4.2-29.2 and OR 6.2, 95% CI 2.1-18.2, respectively]. About one-fourth of patients with unexpected gallbladder findings required further management. Of 914 hemorrhoidectomy specimens, there were 13 (1.4%) histologic abnormalities other than the usually expected lesions in hemorrhoids. None of these altered postoperative management.

CONCLUSIONS

The routine histopathology examination of the appendix and gallbladder, particularly in cases of empyema and patient's age over 60 years, is of value for identifying unsuspected conditions requiring further postoperative management. However, routine histopathologic evaluation of the hemorrhoid seems unnecessary.