Outcome of Surgical Inspection of the Gallbladder in Relation to Final Pathology

Abstract

The present prospective study shows that the surgeon should be able to select those gallbladders needing a microscopic gallbladder examination. Potentially, about 80% of this kind of routine histology can be reduced.

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).…”

“…Three studies 23,28,52 (5633 patients) from countries with a low incidence of GBC in which the surgeon systematically inspected the gallbladder mucosa were included in the subgroup analysis. This resulted in an incidence of truly incidental GBC of 0·04 (95 per cent c.i.…”

“…Data from seven studies 23,28,52,60,63,77,78 (18 330 patients), which reported both the number of specimens with macroscopic abnormalities detected by the surgeon during systematic assessment of the gallbladder and the number of patients with truly incidental GBC, were used to estimate the costs of routine histopathological examination to achieve clinical benefit in one patient. In a hypothetical situation of a selective policy, only 1365 specimens with macroscopic abnormalities (7·4 per cent) would have been sent for further microscopic assessment, whereas 16 965 specimens without macroscopic abnormalities (92·6 per cent) would not have been examined by a pathologist.…”

“…Opponents of a selective policy fear that surgeons might not identify these abnormalities, and argue that the macroscopic examination should be performed by a pathologist who is more experienced in recognizing aberrant findings suspicious for GBC. In a prospective study comparing macroscopic gallbladder examination performed by surgeons and pathologists, Corten and colleagues 52 found strong agreement between both types of assessor (κ = 0·822). Surgeons and pathologists disagreed on only 18 of 319 gallbladder specimens, and no cancer was found in any of these 52 .…”

Safety and cost analysis of selective histopathological examination following appendicectomy and cholecystectomy (FANCY study): protocol and statistical analysis plan of a prospective observational multicentre study

“…In case of gallbladder cancer (GBC), an extended cholecystectomy is only indicated for stage T1b and above 10. Unfortunately, prospective studies regarding macroscopic assessment of appendiceal specimens by the surgeon are lacking, and the few prospective studies investigating the ability of surgeons to identify macroscopic abnormalities in gallbladder specimens are limited by the small numbers of patients 11–13…”