Is it Necessary to Submit Grossly Normal Looking Gall Bladder Specimens for Histopathological Examination?

Abstract

Background: The objectives of the study were to: 1) determine the frequency of incidental malignancy in unsuspected/grossly normal looking gall bladders; 2) determine the frequency of malignancy in suspected/grossly abnormal looking gall bladders. Materials and Methods: This prospective, cross sectional study was carried out at a tertiary care hospital in Pakistan, during a four year period (Jan 2009-dec2012). All the cholecystectomy cases performed for gallstone diseases were examined initially by a surgeon and later on by a pathologist for macroscopic abnormalities and accordingly assigned to one of the three categories i.e. grossly normal, suspicious, abnormal/malignant. Frequency of incidental carcinoma in these categories was observed after receiving the final histopathology report. Results: A total of 426 patients underwent cholecystectomy for cholelithiasis, with a 1:4 male: female ratio. Mean age of the patients was 45 years with a range of 17-80 years. The frequency of incidental gallbladder carcinoma was found to be 0.70 %(n=3). All the cases of gallbladder carcinoma were associated with some macroscopic abnormality. Not a single case of incidental carcinoma gallbladder was diagnosed in 383 'macroscopically normal looking' gallbladders. Conclusions: Incidental finding of gall bladder cancer was not observed in any of macroscopically normal looking gall bladders and all the cases reported as carcinoma gallbladder had some gross abnormality that made them suspicious. We suggest histopathologic examination of only those gall bladders with some gross abnormality.

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

“…Bazoua et al, Emmett et al, and Darmas et al have reported incidental GBC rates of 0.17% (5/2890), 0.25% (12/4776), and 0.27% (4/1452), respectively (7-9). Tayeb et al have noted incidental GBC in only 3 out of 426 (0.70%) cases (10). 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.…”

Safe, selective histopathological examination of gallbladder specimens: a systematic review

“…An additional 18 studies were identified during manual cross‐referencing, resulting in a total of 73 articles, including 232 155 patients, that were eligible for data analysis. These studies were then divided into those performed in countries with a low incidence (39) 6,18–55 and countries with a high incidence (34) 7,56–88 of GBC. Characteristics of all included studies are presented in Table S1 (supporting information).…”

The Necessity for Routine Histopathological Examination of all Cholecystectomy Specimens

“…The authors regarded this policy as effective and safe and there is no possibility to miss any case of invasive adenocarcinoma if only macroscopically abnormal specimens were sent for histopathological examination. [10][11][12][13][14]17,18] In this regard, the safe management of the patient, cost-effectiveness, and the histopathologist's workload should be appreciated. In our study, out of 1176 specimens, only five (0.4%) cases of primary invasive gall bladder adenocarcinoma were found.…”

“…[8] Hence, it has been recommended to submit all gallbladders to routine histopathological examination. [9] However, the role of routine histopathological examination of all cholecystectomy specimens has been revised by many authors [10][11][12][13][14]17,18] This study was conducted to assess the necessity for routine histopathological examination of all Cholecystectomy specimens and to call attention to selective criteria for sending gallbladders to the histopathological examination following cholecystectomy without affecting the patients' safety. Such a selection aims to reduce the number of gallbladders sent for histopathological examination in order to save time, coast and burden on the histopathologists.…”