The diagnostic value of splenectomy in patients without a definitive preoperative diagnosis

Hangge, Patrick T.; Sheaffer, William W.; Neville, Matthew R.; Wasif, Nabil; Gray, Richard; Pockaj, Barbara A.; Stucky, Chee Chee H.

doi:10.1016/j.amjsurg.2018.05.020

Cited by 5 publications

(16 citation statements)

References 7 publications

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“…In accordance with previous data, we found that patients with hematologic malignant neoplasms had increased spleen weight. 9 Our cohort consisted of significant patient segment undergoing splenectomy for diagnostic…”

Section: Discussionmentioning

confidence: 99%

“…Baseline laboratory values were those obtained at the day of splenectomy and included white blood cell count (reported as cells per microliter [to convert to ×10 9 per liter, multiply by 0.001]), hemoglobin level (reported as grams per deciliter [to convert to grams per liter, multiply by 10.0]), and platelet count (reported as ×10 9 per microliter [to convert to ×10 3 per liter, multiply by 1.0]).…”

Section: Patients and Proceduresmentioning

confidence: 99%

“…To convert hemoglobin to grams per liter, multiply by 10.0; platelets to ×10 9 per liter, multiply by 1.0; WBC to ×10 9 per liter, multiply by 0.001.…”

Section: Si Conversion Factorsmentioning

confidence: 99%

“…2 , 6 , 7 , 8 , 9 Owing to these data, the practice of routine uniform pathology review of all surgical spleen specimens has been questioned. Previous publications have identified several features suggestive of a yet-undiagnosed medical condition, such as spleen size, 9 macroscopic appearance, 3 , 4 and patient age 5 ; however, to our knowledge no comprehensive assessment of all clinical factors associated with a diagnostic spleen pathology review has yet been performed. Hence, the specific patient segment that would benefit the most from routine pathology review of splenectomy specimens has not been precisely defined.…”

Section: Introductionmentioning

confidence: 99%

“…Abbreviations: ITP, immune thrombocytopenic purpura; WBC, white blood cells.SI conversion factors:To convert hemoglobin to grams per liter, multiply by 10.0; platelets to ×109 per liter, multiply by 1.0; WBC to ×109 per liter, multiply by 0.001.splenectomy but the difference was not statistically significant (46 [25] years vs 54 [17] years; P = .08) (eTable 1 in the Supplement). Furthermore, clinically noted splenomegaly were uniformly operated in the elective setting (17 [100%]) compared with patients without clinical splenomegaly, in whom emergency surgery was performed in 24 of 63 patients (38%) (P < .001).…”

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confidence: 99%

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Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens

et al. 2021

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IMPORTANCE Previous studies have shown that uniform pathologic review of all splenectomy surgical specimens reveals new clinically actionable diagnoses only in a minority of cases.OBJECTIVE To examine whether the aggregate of clinical, laboratory, imaging, and pathologic preoperative data is associated with a clinically beneficial pathologic study for routine splenectomy surgical specimens. DESIGN, SETTING, AND PARTICIPANTSThis single-center retrospective cohort study included all patients who underwent splenectomy from January 1, 2013, through December 31, 2018, at a single center. Clinical, imaging, and pathologic data were extracted from the institution's electronic medical records system. Data analysis was conducted from June to November 2020. EXPOSURES Undergoing splenectomy for trauma or diagnostic or therapeutic indications. MAIN OUTCOMES AND MEASURES Spleen pathology study resulting in a new medical diagnosis or change in medical management. RESULTS Overall, 90 patients (53 [59%] men) with a median (range) age of 59 (19-90) years underwent splenectomy for therapeutic purposes in 41 patients (45%), trauma in 24 patients (27%), diagnostic purposes in 15 patients (17%), and combined therapeutic and diagnostic purposes in 9 patients (10%). In 14 patients (15%) a new malignant neoplasm was found, and in 8 patients (9%), a new nonneoplastic medical condition was diagnosed. A new pathologic diagnosis resulted in change in medical management in 16 patients (18%). In patients without a prior diagnosis of cancer, 41 of 56 pathology biopsies (73%) were found to be normal whereas in 7 biopsies (13%), a new diagnosis of a hematologic malignant neoplasm was revealed (P < .001). Patients with clinical splenomegaly were significantly more likely to have a new pathologic diagnosis of cancer compared with patients without splenomegaly (15 of 26 [58%] vs 4 of 64 [7%]; P < .001). In 39 of 43 patients (91%) with normal presurgery imaging studies, normal spleen pathology was revealed, whereas in 14 of 17 patients (82%) with abnormal imaging studies, a new hematological malignant neoplasm was diagnosed following pathologic review of the spleen specimen (P < .001). Patients with gross abnormalities on macroscopic examination had a significantly increased likelihood of a hematological cancer diagnosis (17 of 40 [43%]) and a solid cancer diagnosis (4 [10%]) compared with patients with grossly normal specimens (4 of 49 [8%]; P < .001). CONCLUSIONS AND RELEVANCEIn this cohort study, routine pathologic review of spleen specimens was clinically beneficial in patients with splenomegaly, abnormal imaging results, a prior diagnosis of cancer, and with grossly abnormal spleens.

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Section: Discussionmentioning

confidence: 99%

Section: Patients and Proceduresmentioning

confidence: 99%

“…To convert hemoglobin to grams per liter, multiply by 10.0; platelets to ×10 9 per liter, multiply by 1.0; WBC to ×10 9 per liter, multiply by 0.001.…”

Section: Si Conversion Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Association of Preoperative Clinical, Laboratory, Imaging, and Pathologic Data With Clinically Beneficial Pathology Among Routine Splenectomy Specimens

et al. 2021

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The Diagnostic Utility of Splenectomy in Idiopathic Splenomegaly

et al. 2020

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Introduction With increasing frequency, patients with idiopathic splenomegaly are referred to surgeons for splenectomy. We evaluated the diagnostic utility of splenectomy and feasibility of a minimally invasive approach in the face of idiopathic splenomegaly. Methods We retrospectively reviewed 68 patients who underwent splenectomy for idiopathic splenomegaly. The primary endpoint was the rate of definitive diagnosis based on final surgical pathology of the removed spleen. Results Preoperative workup included a bone marrow biopsy and peripheral blood smear in 93% and 100% of patients, respectively, with none having lymphadenopathy warranting biopsy. Splenectomy provided a definitive diagnosis for 44 (64.7%) patients. Of these, 34 (50%) patients had an underlying malignancy, of which more than half were splenic marginal zone lymphoma. There were 33 (48.5%) laparoscopic, 23 (33.8%) open, 10 (14.7%) laparoscopic converted to open, and two (2.9%) laparoscopic hand-assist cases. Conversion to open was due to splenic size [median craniocaudal length 21.8 cm (cm)] in eight and staple line bleeding at the splenic hilum in two patients. Overall, the laparoscopic approach was completed in patients with a smaller splenic size compared to open (median craniocaudal length 15.2 vs. 26.0 cm, p \ 0.0001). The open group had one (1.5%) intra-operative mortality due to uncontrollable hemorrhage. Thirty-day complication rates were similar for laparoscopic and open approaches (p = 0.10). Conclusion Splenectomy is an effective diagnostic modality in determining a pathologic cause for splenomegaly in this patient population. Laparoscopic splenectomy can be performed safely in appropriate cases with craniocaudal splenic size having the largest influence on surgical approach.

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