Gallbladder, Extrahepatic Biliary Tract, and Pancreas Tissue Processing Techniques, and Normal Histology

Seek and ye shall find: the importance of careful macroscopic examination and thorough sampling in 2522 cholecystectomy specimens

“…Currently, most gallbladder specimens in our department are processed according to the generally accepted guideline of three pieces in a single block [1][2][3]. Several studies have considered whether histological evaluation of some cholecystectomy specimens may be safely omitted, for example when the specimen appears macroscopically normal.…”

“…In areas with a low incidence of gallbladder cancer, such as Ireland and the United Kingdom, many non-neoplastic organs must be screened before a case of gallbladder cancer can be identified. There is general consensus that examination of a single tissue block with three sections of tissue to include the cystic duct margin represents the best balance between the necessity on the one hand to identify as many cases with significant pathology as possible, and on the other hand to exercise responsibility in expending scarce resources [1][2][3].…”

Optimal block sampling of routine, non‐tumorous gallbladders

“…The recently reissued ‘Tissue pathways for gastrointestinal and pancreatobiliary pathology’ from the Royal College of Pathologists (RCPath) first recommends sampling of the cystic duct margin and ‘at least one section each of neck, body and any focal lesion’ . This recommendation is referenced by a textbook chapter that itself proposes that ‘cross‐sections of the gallbladder fundus and lateral wall should be submitted, along with the sections from the neck of the gallbladder and cystic duct, including its margin’ . The RCPath document later summarizes its recommendations as: ‘Sample cystic duct margin.…”

“…Sample gallbladder body and any focal lesions.’ The gallbladder section of the online cut‐up manual of the Royal College of Pathologists of Australasia (RCPA) recommends sampling of the cystic duct margin, fundus and body or neck from an ‘unremarkable gallbladder’ and these same sites with ‘any obvious lesions’ from inflamed gallbladders . The references for this section are older versions of the RCPath tissue pathways document and of the aforementioned textbook, as well as three other textbooks, but no specific studies. The College of American Pathologists has issued a protocol for the examination of gallbladders containing carcinoma, but this author could not find national guidance on the sampling of non‐tumorous gallbladders from this or any other US pathology organization.…”

“…A potential limitation of this study is that only four sections were sampled from each non‐tumorous gallbladder, and it is plausible that undetected pathology remained in the unsampled gallbladder. However, the four sections taken are the minimum suggested by the book chapter referred to by the RCPath recommendations, and are more than the minimum proposed by these recommendations . Of these four sections, the neck section did not add anything to the pathological conclusions derived from the body or fundus section.…”