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Slim K, Badon F, Darcha C, Regimbeau JM. Is systematic histological examination of the cholecystectomy specimen always necessary? J Visc Surg 2024; 161:33-40. [PMID: 38103976 DOI: 10.1016/j.jviscsurg.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The histological examination (HE) of all cholecystectomy specimens removed for cholelithiasis is a widespread practice to rule out unrecognized gallbladder cancer. (GBC). But this dogmatic practice has been called into question by recent published data. The aim of this literature review was to answer two questions: (1) can HE be omitted in specific cases; (2) under what conditions is a selective strategy indicated? METHODS A review of the literature was carried out that included selected multicenter studies, registry studies, or meta-analyses. A reliable technique for the surgeon's macroscopic examination of the specimen would allow the selection of dubious cases for HE. The cost-effectiveness of selective HE was discussed. The PICO methodology (population, intervention, comparator, outcome) was used in the selection of articles that compared routine and selective histological examination. RESULTS If cases from countries with a high prevalence of gallbladder cancer are excluded and in the absence of high-risk situations (advanced age, female gender, calcified or porcelain gallbladder, acute cholecystitis, polyps, abnormalities noted intra-operatively), the macroscopic examination of the gallbladder in the operating room has a reliability approaching 100% in the majority of published studies. This would make it possible to omit systematic HE without compromising the diagnosis and prognosis of patients with unsuspected GBC and with a very favorable cost-effectiveness ratio. CONCLUSION Through a selection of patients at very low risk of incidentally-discovered cancer and a routine macroscopic examination of the opened gallbladder, the strategy of selective HE could prove useful in both clinical and economic terms.
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Affiliation(s)
- Karem Slim
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Flora Badon
- Digestive surgery department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Camille Darcha
- Pathology department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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A Dutch prediction tool to assess the risk of incidental gallbladder cancers after cholecystectomies for benign gallstone disease. HPB (Oxford) 2022; 25:409-416. [PMID: 37028827 DOI: 10.1016/j.hpb.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/28/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the increasing implementation of selective histopathologic policies for post-cholecystectomy evaluation of gallbladder specimens in low-incidence countries, the fear of missing incidental gallbladder cancer (GBC) persists. This study aimed to develop a diagnostic prediction model for selecting gallbladders that require additional histopathological examination after cholecystectomy. METHODS A registration-based retrospective cohort study of nine Dutch hospitals was conducted between January 2004 and December 2014. Data were collected using a secure linkage of three patient databases, and potential clinical predictors of gallbladder cancer were selected. The prediction model was validated internally by using bootstrapping. Its discriminative capacity and accuracy were tested by assessing the area under the receiver operating characteristic curve (AUC), Nagelkerke's pseudo-R2, and Brier score. RESULTS Using a cohort of 22,025 gallbladders, including 75 GBC cases, a prediction model with the following variables was developed: age, sex, urgency, type of surgery, and indication for surgery. After correction for optimism, Nagelkerke's R2 and Brier score were 0.32 and 88%, respectively, indicating a moderate model fit. The AUC was 90.3% (95% confidence interval, 86.2%-94.4%), indicating good discriminative ability. CONCLUSION We developed a good clinical prediction model for selecting gallbladder specimens for histopathologic examination after cholecystectomy to rule out GBC.
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Di Mauro D, Orabi A, Myintmo A, Reece-Smith A, Wajed S, Manzelli A. Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma. Discov Oncol 2021; 12:4. [PMID: 35201433 PMCID: PMC7884302 DOI: 10.1007/s12672-021-00399-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/26/2021] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy-this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens' examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. METHODS Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student's t-test and ANOVA. RESULTS Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in six cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease-73.7 [Formula: see text] 5.38 years vs 55.8 [Formula: see text] 0.79 years (p < 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage-one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression-median survival was 7 months (range 2-14). CONCLUSIONS In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.
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Affiliation(s)
- Davide Di Mauro
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK.
| | - Amira Orabi
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Aye Myintmo
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Alex Reece-Smith
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Shahjehan Wajed
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Antonio Manzelli
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
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Butti AK, Yadav SK, Verma A, Das A, Naeem R, Chopra R, Singh S, Sarin N. Chronic calculus cholecystitis: Is histopathology essential post-cholecystectomy? Indian J Cancer 2020; 57:89-92. [PMID: 32129299 DOI: 10.4103/ijc.ijc_487_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Carcinoma of the gall bladder (GB) is the most common malignancy of the gastrointestinal tract. One percent of cholecystectomy specimens show incidental gall bladder cancers (GBCs). Aim Our aim of the study to was evaluate the utility of routine histopathology of cholecystectomy specimens removed with a diagnosis of gall bladder diseases (GBD). Materials and Methods A retrospective study was done reviewing the histopathological records of 906 patients who underwent cholecystectomy. Demographic details, gross findings, and microscopic findings noted. All the cases were categorized into two groups, A and B. Group A included the cases with any gross abnormality including wall thickness ≥4 mm and group B included rest of the cases. Results Majority of the patients were in the age group of 31-40 years of age. Out of 906 patients studied, majority of them were females with F:M ratio of 6.14:1. Of the 47 cases which were included in group A (with macroscopic abnormality), six cases had gall bladder carcinoma on microscopy. One case from group B with macroscopically normal-appearing GB had invasive carcinoma on microscopy. In our study, we found a sensitivity of 85.71% and specificity of 95.44%, while positive predictive value (PPV) was 91.11% and negative predictive value (NPV) was 99.65% of macroscopic abnormality in the diagnosis of invasive carcinoma. Conclusion All cholecystectomy specimens must be examined by histopathologists who must decide whether processing for microscopy is needed. Microscopic examination may be reserved for the specimen with a macroscopic lesion. This will result in a reduction of costs and pathology workload without compromising patient management.
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Affiliation(s)
- Amul K Butti
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Shakti K Yadav
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Alekh Verma
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Abhijit Das
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Roshina Naeem
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Ratna Chopra
- Department of Surgery, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Sompal Singh
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Namrata Sarin
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
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Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, Tanis PJ, Bemelman WA. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg 2020; 107:1414-1428. [PMID: 32639049 PMCID: PMC7540681 DOI: 10.1002/bjs.11759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.
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Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - J E Tuijp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - L Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Corten B, Leclercq W, Roumen R, van Zwam P, Dejong C, Slooter G. Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified. Eur J Surg Oncol 2020; 46:572-576. [DOI: 10.1016/j.ejso.2019.11.497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 01/24/2023] Open
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Corten BJGA, Leclercq WKG, Dejong CH, Roumen RMH, Slooter GD. Selective Histological Examination After Cholecystectomy: An Analysis of Current Daily Practice in The Netherlands. World J Surg 2019; 43:2561-2570. [PMID: 31286186 DOI: 10.1007/s00268-019-05077-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The 2016 Dutch national guidelines on handling of a removed gallbladder for cholelithiasis proposes a selective histopathologic policy (Sel-HP) rather than routine policy (Rout-HP). The aim of this study was to determine the current implementation of the present guideline and the daily practice of Sel-HP. METHODS Surgeons who were engaged in gallbladder surgery in the Netherlands and were involved in local hospitals' gallbladder protocols completed a questionnaire study regarding gallbladder policy, between December 2017 and May 2018. Data were analyzed using standard statistics. RESULTS A 100% response rate was obtained (n = 74). Approximately 64% of all gallbladders (n = 22,500) were examined microscopically. Sixty-nine (93.2%) hospitals confirmed they were aware of the new guidelines, and 56 (75.7%) knew the guideline was adjusted in favor of Sel-HP. Half of the hospitals (n = 35, 47.3%) had adopted a Sel-HP, and 39 (52.7%) a Rout-HP. Of the 39 hospitals who had a Rout-HP, 36 were open to a transition to a Sel-HP although some expressed the need for more evidence on safety or novel guidelines. CONCLUSIONS The current implementation of the 2016 Dutch guideline advising a selective microscopic analysis of removed gallbladders for gallstone disease is suboptimal. Evidence demonstrating safety and cost-effectiveness of an on demand histopathological examination will aid in the implementation process.
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Affiliation(s)
- B J G A Corten
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.
| | - W K G Leclercq
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - C H Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - R M H Roumen
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - G D Slooter
- Department of Surgery, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands
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Patel K, Dajani K, Iype S, Chatzizacharias NA, Vickramarajah S, Singh P, Davies S, Brais R, Liau SS, Harper S, Jah A, Praseedom RK, Huguet EL. Incidental non-benign gallbladder histopathology after cholecystectomy in an United Kingdom population: Need for routine histological analysis? World J Gastrointest Surg 2016; 8:685-692. [PMID: 27830040 PMCID: PMC5081550 DOI: 10.4240/wjgs.v8.i10.685] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/26/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.
METHODS Incidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine cholecystectomy. All cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively analysed. Further data was collected on all specimens demonstrating carcinoma, dysplasia and polypoid growths.
RESULTS The study included 4027 patients. The majority (97%) of specimens exhibited gallstone or cholecystitis related disease. Polyps were demonstrated in 44 (1.09%), the majority of which were cholesterol based (41/44). Dysplasia, ranging from low to multifocal high-grade was demonstrated in 55 (1.37%). Incidental primary gallbladder adenocarcinoma was detected in 6 specimens (0.15%, 5 female and 1 male), and a single gallbladder revealed carcinoma in situ (0.02%). This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens, including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder malignancies.
CONCLUSION Routine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.
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Basak F, Hasbahceci M, Canbak T, Sisik A, Acar A, Yucel M, Bas G, Alimoglu O. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases. Ann R Coll Surg Engl 2016; 98:280-3. [PMID: 26924485 PMCID: PMC5226033 DOI: 10.1308/rcsann.2016.0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Cholecystectomy for benign gallbladder diseases can lead to previously undiagnosed gallbladder cancer during histopathological evaluation. Despite some controversy over its usefulness, histopathological evaluation of all gallbladder specimens is common in most hospitals. We evaluated the results of routine pathology of the gallbladder after cholecystectomy for benign gallbladder diseases with regard to unexpected primary gallbladder cancer (UPGC). Methods Patients undergoing cholecystectomy because of benign gallbladder diseases between 2009 and 2013 were enrolled in this study. All gallbladder specimens were sent to the pathology department, and histopathological reports were examined in detail. The impact of demographic features on pathological diagnoses and prevalence of UPGC assessed. Data on additional interventions and postoperative survival for patients with UPGC were collected. Results We enrolled 1,747 patients (mean age, 48.7±13.6 years). Chronic cholecystitis was the most common diagnosis (96.3%) and was associated significantly with being female (p=0.001). Four patients had UPGC (0.23%); one was stage T3 at the time of surgery, and the remaining three cases were stage T2. Conclusions Routine histopathological examination of the gallbladder is valuable for identification of cancer that requires further postoperative management.
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Affiliation(s)
- F Basak
- Umraniye Education and Research Hospital , Turkey
| | | | - T Canbak
- Umraniye Education and Research Hospital , Turkey
| | - A Sisik
- Umraniye Education and Research Hospital , Turkey
| | - A Acar
- Umraniye Education and Research Hospital , Turkey
| | - M Yucel
- Umraniye Education and Research Hospital , Turkey
| | - G Bas
- Umraniye Education and Research Hospital , Turkey
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Jamal K, Ratansingham K, Siddique M, Nehra D. Routine histological analysis of a macroscopically normal gallbladder--a review of the literature. Int J Surg 2014; 12:958-62. [PMID: 25058481 DOI: 10.1016/j.ijsu.2014.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 05/21/2014] [Accepted: 07/10/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND 70,000 cholecystectomies were performed in the United Kingdom in 2011-2012. Currently it is standard practice to submit all gallbladder specimens for routine histology to exclude malignancy. The aim of this systematic review was to establish whether a normal macroscopic appearance to the gallbladder at the time of cholecystectomy is sufficient to rule out malignancy and therefore negate the need for routine histology. METHODS Relevant articles that were published between 1966 and January 2013 were identified through electronic databases. RESULTS 21 studies reported on 34,499 histologically analysed specimens. 172/187 (92%) of gallbladder cancers demonstrated intra-operative macroscopic abnormality. Studies that opened the specimens intra-operatively identified all cancers, whereas gross macroscopic visualization resulted in 15 potentially missed cancers (p = 0.10). In patients of European ethnicity, gallbladder cancer in a macroscopically normal looking gallbladder was identified in only one study; however all of these patients were above the age of 60. The incidence of gallbladder cancer was significantly raised in ethnic groups from high risk areas (p = 0.0001). CONCLUSIONS A macroscopically normal gallbladder in patients of European ethnicity under the age of 60 may not require formal histopathology. The best method for intra-operative examination may involve opening the specimen to allow inspection of the mucosa and wall, however this needs further investigation. In the context of the volume of gallbladder surgery being performed there is the potential for significant cost and time savings.
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Affiliation(s)
- K Jamal
- Epsom and St Helier's Hospital, Surrey, United Kingdom.
| | | | - M Siddique
- Epsom and St Helier's Hospital, Surrey, United Kingdom.
| | - D Nehra
- Epsom and St Helier's Hospital, Surrey, United Kingdom.
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Van Wicklin SA. Clinical Issues—July 2014. AORN J 2014. [DOI: 10.1016/j.aorn.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, Uttar Pradesh, India
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Jayasundara JASB, de Silva WMM. Histological assessment of cholecystectomy specimens performed for symptomatic cholelithiasis: routine or selective? Ann R Coll Surg Engl 2013; 95:317-22. [PMID: 23838492 PMCID: PMC4165132 DOI: 10.1308/003588413x13629960046471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/21/2022] Open
Abstract
Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise.
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Affiliation(s)
- J A S B Jayasundara
- General Surgical Unit (Ward 19), National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
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Romero-González RJ, Garza-Flores A, Martínez-PérezMaldonado L, Díaz-Elizondo JA, Muñiz-Eguía JJ, Barbosa-Quintana A. Gallbladder selection for histopathological analysis based on a simple method: a prospective comparative study. Ann R Coll Surg Engl 2012; 94:159-64. [PMID: 22507718 PMCID: PMC3705227 DOI: 10.1308/003588412x13171221589810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2011] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION After a cholecystectomy, the current and traditional practice is to send each resected gallbladder to the pathologist for analysis. Some reports have suggested the possibility of selecting only those gallbladders that need to be analysed. The purpose of this study was to show a simple method for selecting which gallbladders should be sent to the pathologist. METHODS A prospective comparative study was carried out. Two 'tests' were performed in 150 patients to detect or rule out gallbladder cancer. The first test included the patient's variables and a macroscopic gallbladder analysis performed by the surgeon (MGAS). The second test was the analysis performed by the pathologist. The results were compared. RESULTS Of the 150 patients, 132 were women and 18 men; 130 were under 60 years old. One patient had inflammatory bowel disease, seven had changes on ultrasonography and in four cases intra-operative disturbances were observed. During the MGAS, disturbances were found in 30 patients. Eighty-one cases (54%) had at least one or more risk factors for gallbladder cancer.
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16
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Selective histopathology in cholecystectomy for gallstone disease. Indian J Gastroenterol 2010; 29:26-30. [PMID: 20373083 DOI: 10.1007/s12664-010-0005-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 08/28/2009] [Accepted: 10/11/2009] [Indexed: 02/04/2023]
Abstract
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.
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Abstract
Gallbladder cancer (GBC) shows a marked geographical variation in its incidence, with the highest figures being seen in India and Chile and relatively low levels in many Western countries. Risk factors for its development include the presence of gallstones, infection and the presence of an anomalous pancreatobiliary ductal junction. It can arise from either a pathway involving metaplasia or dysplasia or one in which there is a pre-existing adenoma. The former is the more common and, because it is often not associated with a macroscopically recognizable lesion, leads to the recommendation that all gallbladders need to be examined microscopically. Accurate staging of invasive cancers is essential to determine prognosis and treatment, and this requires extensive tumour sampling. A number of genetic alterations have been identified in the preinvasive and invasive stages of GBC and they support the morphological evidence of there being two pathways by which tumours develop. Some of these genetic changes are associated with particular risk factors. For example, cases with anomalous pancreatobiliary ductal junction show a higher frequency of K-ras mutations. Some changes are associated with differences in prognosis. For example, cancers without expression of p21 but with expression for p27 have a better prognosis, whereas those that express c-erb-B2 have a worse one. Work has also been done on identifying clinical, imaging and other factors that indicate that patients have a higher risk of having GBC. This is particularly important in high-incidence areas in which GBC is a significant public health problem.
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Affiliation(s)
- Robert David Goldin
- Department of Histopathology, Imperial College Faculty of Medicine at St Mary's, London, UK.
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18
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Darmas B, Mahmud S, Abbas A, Baker AL. Authors' Response. Ann R Coll Surg Engl 2007. [DOI: 10.1308/003588407x209482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- B Darmas
- Department of General Surgery, Wrexham Maelor Hospital Wrexham, UK
| | - S Mahmud
- Department of General Surgery, Wrexham Maelor Hospital Wrexham, UK
| | - A Abbas
- Department of General Surgery, Wrexham Maelor Hospital Wrexham, UK
| | - AL Baker
- Department of General Surgery, Wrexham Maelor Hospital Wrexham, UK
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Darmas B, Mahmud S, Abbas A, Baker AL. Is there any justification for the routine histological examination of straightforward cholecystectomy specimens? Ann R Coll Surg Engl 2007; 89:238-41. [PMID: 17394706 PMCID: PMC1964718 DOI: 10.1308/003588407x168361] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Gall bladder carcinoma is a rare malignancy that carries a very poor prognosis. Laparoscopic cholecystectomy (LC) is established as the gold-standard treatment for symptomatic gall stones. The aim of the study was to assess the incidence of gall bladder carcinoma and the possibility of reducing the routine histological examination of gall bladder specimens. PATIENTS AND METHODS Pathology laboratory data of gall bladder specimens over a period of 5 years (June 2000 to July 2005) were analysed retrospectively. The case notes were retrieved in all cases of malignancies. RESULTS The total number of specimens was 1452. Four (0.27%) cases of primary gall bladder carcinoma, one case of primary B-cell lymphoma and one secondary carcinoma were detected as well as one case of intra-epithelial neoplasia. Operative notes revealed that there was a high index of suspicion of malignancy in all cases. Of the 4 primary gall bladder carcinomas, 3 were stage T2 and one T4. Pre-operative ultrasound suspected carcinoma in only one case but a thickened gall bladder wall was noted in all cases. CONCLUSIONS All cases of gall bladder carcinoma were suspected pre-operatively or intra-operatively. Histological examination did not alter the management or outcome in any of the cases. We suggest that selectively sending specimens for histopathological examination would result in reduced demands on the histopathology department without compromising patient safety.
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Affiliation(s)
- B Darmas
- Department of General Surgery, Wrexham Maelor Hospital, Wrexham, UK.
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Matthyssens LE, Champault GG. Author's reply: Routine surgical pathology in general surgery ( Br J Surg 2006; 93: 362–368). Br J Surg 2006. [DOI: 10.1002/bjs.5522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L E Matthyssens
- Department of Surgical Oncology, University Hospital Gasthuisberg, University of Leuven, Belgium
| | - G G Champault
- Department of General and Digestive Surgery, CHU Jean Verdier, AP-HP, UFR Léonard de Vinci, Université Paris-XIII, France
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Dix FP, Bruce IA, Krypcyzk A, Ravi S. A selective approach to histopathology of the gallbladder is justifiable. Surgeon 2004; 1:233-5. [PMID: 15570768 DOI: 10.1016/s1479-666x(03)80023-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent changes in the NHS have led to a considerably increased workload for histopathologists prompting the publication of guidelines from the Royal College of Pathologists regarding specimen analysis. In most hospitals, cholecystectomy specimens are routinely sent for histology regardless of whether or not there is any visible macroscopic abnormality suggestive of malignancy. Our aim was to assess whether it would be safe to adopt a policy of processing only suspicious gallbladders without compromising patient management and outcome. METHODS A retrospective analysis of all cholecystectomies performed between 1995 and 1999 was conducted using computerised histopathology records and patient notes. The histopathology department has a standardised procedure for the evaluation of cholecystectomy specimens and all gallbladders had been processed in this manner. RESULTS 1308 patients had undergone cholecystectomy (mean 262/year). All specimens had been sent for histology: 1249 of the specimens showed chronic cholecystitis, 38 acute cholecystitis or empyema and 16 were removed as part of another procedure. In five gallbladders there was evidence of primary carcinoma. In all cases the gallbladder was opened at the time of surgery (as commented upon in the operation notes) and all showed macroscopic evidence suggestive of carcinoma. Pre-operative ultrasound scanning identified probable carcinoma in three of the five cases. CONCLUSIONS All cases of gallbladder carcinoma were diagnosed pre-operatively or intra-operatively and a histological diagnosis did not alter the management or outcome of any of these patients. Selective histopathology of the gallbladder is safe and may be a more measured approach saving histolopathology departments time and money.
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Affiliation(s)
- F P Dix
- Department of Surgery, Blackpool Victoria Hospital, UK.
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Ríos Zambudio A, Sánchez Bueno F, García Marcilla JA, Robles Campos R, Tamayo Rodríguez ME, Balsalobre Salmerón MD, Parrilla Paricio P. [Prognostic factors in gallbladder cancer]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:281-6. [PMID: 11459563 DOI: 10.1016/s0210-5705(01)70175-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Carcinoma of the gallbladder is the most frequent biliary tract lesion but the 5-year survival is less than 5%. The aim of this study was to analyze the influence of several clinico-pathological variables on survival in a series of 226 carcinomas of the gallbladder. PATIENTS AND METHODS The results were retrospectively analyzed and prognostic factors were identified by univariate statistical analysis and Cox regression model. All patients underwent surgery and in 67 of these (29.6%), surgery was potentially curative. In 63 patients (27.9%) diagnosis was made when the resected gallbladder was studied for benign disease. Tumor node metastasis (TNM) stage was 0 in 7 patients (3.1%), stage I in 19 patients (8.4%), stage II in 21 patients (9.3%), stage III in 61 patients (27%) and stage IV in 118 patients (52%). RESULTS Overall 5-year survival was 17.3%. In the univariate analysis, significant variables were the presence of jaundice, weight loss, palpation of abdominal tumors at diagnosis, surgical technique, TNM stage and the three variables of this system (T: size, N: adenopathies; M: distant metastasis). In the multivariate analysis, the three variables of the TNM system and surgical technique were significantly associated with survival. CONCLUSIONS The most important prognostic factor was TNM stage. Currently, radical cholecystectomy in stages II and III has become another important prognostic factor.
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Affiliation(s)
- A Ríos Zambudio
- Médico interno residente de Cirugía, Servicio de Cirugia General del Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, Murcia.
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