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

Abstract

Objective: Routine histopathological examination of all gallbladder specimens, regardless of the clinical characteristics of the patient or macroscopic aspect of the gallbladder, is the current approach to detect the presence of gallbladder carcinoma. The aim of the present study was to assess whether or not it would be safe to adopt a policy of processing only gallbladder specimens with preoperative or intraoperative suspicion for malignancy without compromising patient safety. Material and Methods: From January 2009 to June 2017, all histopathology reports of 3423 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed in two university hospitals. Results: A total of 3423 gallbladder specimens submitted for histopathological examination during the study period were included into the study. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 2792 (81.6%), acute cholecystitis in 237 (6.9%), and cholesterolosis in 223 (6.5%) patients. Dysplasia was found in 5 (0.14%) patients, and gallbladder carcinoma was detected in 4 (0.11%) patients. All patients with gallbladder carcinoma were diagnosed either preoperatively or intraoperatively, and none of the patients with gallbladder carcinoma were diagnosed from the histopathological examination. Conclusion: A strategy of selective approach for histopathological examination of gallbladder specimens may be safe in areas with very low incidence of gallbladder carcinoma. Such selective strategy is more cost-effective, reduces the workload of pathologists, and does not appear to compromise patient outcome.

Retrospective histopathologic findings of routine cholecystectomy specimens in a teaching hospital in North East India

“…The incidence of most benign pathologies [ Table 2 ] were similar to the previous reports. [ 17 18 ] However, the incidence of xanthogranulomatous cholecystitis (3.45%) was found to be higher in the present series than most other reported series. Limaiem F et al ,[ 18 ] reported 0.30% and Benkhadoura M et al .…”

“…[ 18 ] Benkhadoura M et al . [ 17 ] reported a higher incidence of chronic cholecystitis as 81.60% in their series.…”

“…[ 15 ] Benkhadoura M et al . [ 17 ] and Limaiem F et al . [ 18 ] too suggested that all gallbladder specimens should be examined properly after surgery, and only grossly abnormal appearing gallbladder specimens should be sent for histopathological examination.…”

“…Limaiem F et al ,[ 18 ] reported 0.30% and Benkhadoura M et al . [ 17 ] documented 0.10% of xanthogranulomatous cholecystitis in their series.…”

Evaluation of the Cost Effectiveness of Routine Histopathologic Femoral Head Analysis in Hip Arthroplasty

“…Studies conducted in other surgical fields have reported similar analyses on hernia sacs, intervertebral discs, adenoid tissue, and gallbladders with mixed results on the cost effectiveness 13) . For example, The College of American Pathologists 14) continues to recommend microscopic examination of abdominal hernias, but has now left submission of inguinal hernias up to the discretion of the pathologist 15) . Similarly, submission of gallbladder specimens to detect the presence of gallbladder carcinoma is still standard procedure; however, because many patients with cancer are captured either preoperatively or intraoperatively, the process is falling out of favor 16) .…”