Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?

Lemarchand, Nicolas; Tanne, Florence; Aubert, M; Benfredj, Paul; Denis, J; Dubois-Arnous, Noëlle; Fellous, K; Ganansia, Roland; Senéjoux, A.; Soudan, D.; Puy-Montbrun, Thierry

doi:10.1016/s0399-8320(04)95044-0

Cited by 30 publications

(32 citation statements)

References 3 publications

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“…15 Although the accuracy of systematic histologic examination after hemorrhoidectomy is still being discussed, the number of unknown intraepithelial neoplasias is not insignificant. 16,17 Anal smears are easy to perform. The diagnostic cytologic criteria bear some resemblance to the criteria used in cervicovaginal samples, with a few differences.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Anal Cytologic Abnormalities in a French Referral Population: A Prospective Study with Special Emphasis on HIV, HPV, and Smoking

Etienney¹,

Vuong²,

Daniel³

et al. 2008

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 99%

Prevalence of Anal Cytologic Abnormalities in a French Referral Population: A Prospective Study with Special Emphasis on HIV, HPV, and Smoking

Etienney¹,

Vuong²,

Daniel³

et al. 2008

Diseases of the Colon &Amp; Rectum

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“…A study of Matthyssens et al highlighted an exceptionally low incidence of anal carcinoma, particularly in the absence of grossly identified pathologic alterations [8]. These observations have also been supported by other researchers [31]. Hemorrhoids represent low yield specimens and could easily be left unexamined, unless there is a valid clinical justification for histopathologic examination.…”

Section: Hemorrhoidsmentioning

confidence: 85%

Does everything a surgeon takes out have to be seen by a pathologist? A review of the current pathology practice

2015

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Histopathologic examination of surgically removed tissues and organs is an important aspect of modern hospital quality health care. Most surgical specimens deserve to be submitted for pathologic examination, which may yield valuable new information relevant for the future treatment of the patient. A small number of specimens, recognized as providing limited or no valuable clinical data during pathologic examination, may be placed on the list of specimens "exempt from submission" or those that are labeled as "for gross examination only." Guidelines written by the committees of the national regulatory organizations provide general orientation on how to deal with various specimens, but the final decision on which type of specimen to eliminate and which ones to include for pathologic examination rests on local governing and advisory bodies of each institution. Particular lists of specimens exempt from pathologic examination are best generated through a consensus agreement of clinical and laboratory physicians. Even though there is general nationwide and even international consensus on which types of specimens deserve pathologic examination and which do not, there are still discussions about the necessity of some pathologic examinations.

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“…Appendicectomy and cholecystectomy are the most common procedures performed in a general surgical practice. Importance of routine histopathologic examination of the surgical specimens is now being debated because many incidental findings have little clinical significance [3,4]. However, sometimes the clinician might miss an occult malignancy even intraoperatively, which could be detected only on microscopy.…”

Section: Discussionmentioning

confidence: 99%

“…A small number of literature data studied the benefits of histopathologic examination of these two common surgical specimens [2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Routine Histopathologic Examination of Two Common Surgical Specimens—Appendix and Gallbladder: Is It a Waste of Expertise and Hospital Resources?

Ramraje

Pawar

2012

Indian J Surg

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This study was undertaken to assess whether a routine histopathologic examination of two common surgical specimens (appendix and gallbladder) is needed and whether routine histopathologic examination has an impact on further management of patients. Histopathology reports of patients who had undergone appendicectomy and cholecystectomy, between 2006 and 2010, were analyzed retrospectively in the department of pathology of a tertiary care hospital. The case notes were retrieved in all cases of malignancies. Patients having a clinical diagnosis or suspicion of malignancy were excluded. The incidence and impact of unexpected pathologic diagnosis on postoperative management were noted. The study period included a total of 1,123 and 711 appendicectomy and cholecystectomy specimens, respectively. Fifteen (1.336 %) cases of appendicectomy specimens revealed incidental unexpected pathological diagnoses, which included tubercular appendicitis (n0 2), parasite (n 08), neuroma (n 01), carcinoid (n 02), pseudomyxoma (n 01), and adenocarcinoma (n 01). About 88 % of such unexpected appendiceal findings had an impact on postoperative treatment. Unexpected pathologic gallbladder findings were found in 12 (1.68 %) of 711 cholecystectomy specimens. In 6 (0.84 %) cases, gallbladder cancer (GBC) was detected. Additional further management was required in 50 % of patients with unexpected gallbladder findings. Twenty of the total 1,834 specimens (1.090 %) had an impact on patient management or outcome and were not suspected on macroscopic examination at the time of surgery. These would have been missed had the specimens not been examined microscopically. The intraoperative diagnosis of the surgeon is therefore sometimes doubtful in detecting abnormalities of the appendix and gallbladder. This study supports the sending of all appendicectomy and cholecystectomy specimens for routine histopathological examination. Appendix and gallbladder should undergo routine histopathological examination. This is important in patients with advanced age and gallstones. Also, it is of great value in identifying unsuspected conditions which require further postoperative management. Selectively sending specimens for histopathological examination can result in reduced workload on the histopathology department without compromising patient safety.

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Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?

Cited by 30 publications

References 3 publications

Prevalence of Anal Cytologic Abnormalities in a French Referral Population: A Prospective Study with Special Emphasis on HIV, HPV, and Smoking

Prevalence of Anal Cytologic Abnormalities in a French Referral Population: A Prospective Study with Special Emphasis on HIV, HPV, and Smoking

Does everything a surgeon takes out have to be seen by a pathologist? A review of the current pathology practice

Routine Histopathologic Examination of Two Common Surgical Specimens—Appendix and Gallbladder: Is It a Waste of Expertise and Hospital Resources?

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