Safe, selective histopathological examination of gallbladder specimens: a systematic review

Abstract

Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.

Role of Detailed Intraoperative Macroscopic Examination of Cholecystectomy Specimens for Deciding Specimens Needing Histological Evaluation for Diagnosing Incidental Carcinoma of Gallbladder at the Earliest? A Systematic Review

“…This finding supports the view of a previously done review by Jamal K et al 42 that normal macroscopy of gallbladders is a prerequisite for doing safe selective histology of gallbladders for identifying the IGBCs. This systematic review supports the view by Bastiaenen et al 43 that a Selective histopathological examination of cholecystectomy specimens after an initial macroscopic assessment by the surgeon seems safe. In addition, this review also supports previously done review by Jayasundra et al 12 and Khan et al 44 having an opinion that selective histopathology can be considered in regions having low GBC incidence, and the selective histological examination view of Jamal et al 42 , by showing that a more confident selective histology is possible after detailed intraoperative macroscopic examination.…”

Authors’ Reply: Routine Pathology and Postoperative Follow‐Up are not Cost‐Effective in Cholecystectomy for Benign Gallbladder Disease

“…A large prospective nationwide study that could conform these results is currently recruiting and might also tell us whether surgeons can sufficiently macroscopically examine gallbladder specimens. [4]…”

Estimating the influencing factors for T1b/T2 gallbladder cancer on survival and surgical approaches selection

“… 27 Despite the fact that intraoperative histopathology was expensive and would add significantly to pathologists' workload, it was considered standard practice for detecting the presence of GBC. 28 Nevertheless, the diagnostic modalities and the time required for confirmation varied among GBC patients, and they did not significantly prolong the TTT or negatively impact the survival outcomes. Furthermore, surgeons should select the optimal diagnostic modalities based on the local medical conditions rather than the time required for diagnosis.…”

“…Additionally, surgeons relied on the emerging positron emission tomography‐computed tomography for more precise GBC staging 27 . Despite the fact that intraoperative histopathology was expensive and would add significantly to pathologists' workload, it was considered standard practice for detecting the presence of GBC 28 . Nevertheless, the diagnostic modalities and the time required for confirmation varied among GBC patients, and they did not significantly prolong the TTT or negatively impact the survival outcomes.…”