Indications for Routine Pathologic Examination of Specimens Removed During Trauma Operations

Abstract

The routine pathology review of specimens obtained during trauma operations did not alter patient care and should not continue. In all instances of abnormal pathology, preoperative imaging or gross intraoperative findings led to increased suspicion of occult disease. The suggestion of abnormalities on imaging or intraoperatively warrants pathologic examination, especially in older patients.

Clinicopathological features of splenectomy specimens: Experience of 16 years

“…Ancak literatürde splenektomi materyallerinin klinikopatolojik özelliklerini konu alan az sayıda çalışma bulunmaktadır. Ülkeler arasında ve yaşa göre sırala-mada farklılıklar olmakla birlikte, en sık splenektomi endikasyonları arasında travmaya bağlı rüptür, hematolojik hastalıklar, infeksiyonlar ve batın içi diğer organ patolojileri nedeniyle uygulanan operasyonlarda prosedür gereği yapılanlar ilk sıralarda yer almaktadır (3,4,7,8) . Çalışmamızda da benzer durumlar splenektomi endikasyonlarının büyük çoğunluğunu oluşturmakta-dır.…”

“…Gertz ve ark. 'nın (8) 475 travmatik splenektomi içeren çalışmalarında, histolojik incelemede 12 hastada patoloji saptanmıştır. On iki hastanın 5'inde klinik olarak önem taşıyan hastalıklar (2'si granülomatöz, 1'i amiloidoz, 1'i diffüz büyük B hücreli lenfoma) bulunmaktadır.…”

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

“…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.…”

“…Several retrospective studies have addressed the clinical yield of this approach, indicating that only 0.5% to 1.2% of patients who underwent splenectomy for trauma-related reasons had new clinically significant findings found on pathology review. [2][3][4][5] Conversely, in patients undergoing diagnostic splenectomy, typically for the workup of splenomegaly or discrete mass lesions of the spleen, much higher rates of a new pathologic diagnosis are established, with lymphoma being a predominant etiology. 2,[6][7][8][9] Owing to these data, the practice of routine uniform pathology review of all surgical spleen specimens has been questioned.…”

“…In this analysis, we found that a new diagnosis of malignant neoplasm was detected on pathology review in less than 20% of patients; furthermore, we established specific clinical, pathologic, and imaging parameters associated with an increased likelihood of a new cancer diagnosis and of new clinical management decisions based on the pathology findings.The role of routine histologic evaluation of splenectomy specimens remains a matter of debate most prominently in the clinical setting of trauma, where previous studies indicate a low probability of detecting previously undiagnosed medical conditions. Indeed, a study by Gertz and colleagues,5 using the trauma registry of the Los Angeles County and University of Southern California Medical Center, reviewed 1686 surgical specimens (of which 475 were spleen specimens) obtained during trauma surgeries, and only 0.5% showed a new diagnosis of malignant neoplasm. Importantly, these new pathologic data did not result in changed medical management for any patients, leading the authors to conclude that routine pathology review of specimens obtained during trauma operations is not indicated.…”