Is It Necessary to Send Gallbladder Specimens for Routine Histopathological Examination after Cholecystectomy? The Use of Macroscopic Examination

Abstract

Background/Aims: Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of gallbladder carcinoma (GBC). However, there is no evidence for the benefit of this costly practice. Our aim was to determine whether a selective strategy based on macroscopic appearance of gallbladder specimens is a reliable strategy to exclude them from histopathological examination. Methods: A retrospective study was conducted from January 2007 until November 2011 in a large community hospital in the Netherlands. All gallbladder specimen reports (n = 1,393) after cholecystectomy were included and searched for abnormal findings. Reports were excluded when a full histopathological report was not available (n = 18). Results: Out of the 1,375 patients, 185 had a macroscopically abnormal gallbladder specimen. Of these patients, 6 had GBC. All patients with GBC had macroscopic abnormalities, giving a negative predictive value of 100% to exclude gallbladder specimens from histopathological examination based on macroscopic abnormalities. Conclusions: Based on our study it seems justified to exclude gallbladder specimens from histopathological examination based on the absence of macroscopic abnormalities. A more selective policy will reduce medical costs, saving EUR 1.3 million a year in the Netherlands alone, whilst maintaining patient safety.

Routine histopathological examination of gallbladder specimens after cholecystectomy: Is it time to change the current practice?

“…All cases of incidental GBC in these studies had a macroscopically abnormal gallbladder; hence, these studies suggest that it is safe to adopt a selective approach to Some studies showed that it may be justified to exclude gallbladder specimens from the HPE by using macroscopic examination. van Vliet et al have shown that of the 1375 gallbladder specimens examined macroscopically, not one incidental GBC is found (11). Of the 185 (13.5%) specimens of all gallbladder specimens that showed macroscopic abnormalities for which they would require further HPE in case of a selective policy, GBC was found in 6 specimens.…”

“…There has been a concern about the presence of early GBC in a normal-looking gallbladder specimen. However, simple cholecystectomy is considered adequate in these patients, and no further therapy is required (8,(11)(12)(13).…”

Effect of Reoperation on Long-Term Outcome of pT1b/T2 Gallbladder Carcinoma After Initial Laparoscopic Cholecystectomy

“…When GBC was suspected before or during surgery and diagnosed by intraoperative frozen-section biopsy, the surgery was immediately converted to open surgery and such patients were assigned to group I. 5 Reoperation was recommended for nearly all patients diagnosed with pT1b and pT2 lesions. The usual extent of reoperation included wedge resection of the gallbladder bed, regional lymph node dissection, removal of attached omental tissues, and optional extrahepatic bile duct resection (group III).…”

Gastric Mucosal Changes and Ghrelin Expression and Their Relation to Weight Reduction After Sleeve Gastrectomy

“…The observation of lack of malignancies further raises the question of any added value of routine histopathological examination of the resected part of the stomach after LSG as AbdullGaffar et al [18] implied. In light of financial restrictions that warrants evidence-based decision-making based on the cost-effectiveness concept, routine histopathological examination of surgical specimens has been previously questioned [24,25].…”