The Necessity for Routine Histopathological Examination of all Cholecystectomy Specimens

Abstract

Objectives: Cholecystectomy is the established treatment for symptomatic gall stones and cholecystitis. In our locality, all cholecystectomy specimens are routinely sent for histopathological examination regardless of the presence or absence of preoperative or intraoperative suspicion of malignancy. This has led to an increased workload for the histopathologists. This study was conducted to assess the necessity for routine histopathological examination of all cholecystectomy specimens and to call attention to a selective criteria for sending gallbladders to the histopathological examination. Materials and methods: A retrospective analysis of computerized histopathological reports of 1176 cholecystectomy specimens and the available patients clinical data for the last ten years. Results: Analysis of 1176 cholecystectomy specimens during the last ten years, revealed five cases of primary invasive adenocarcinoma (0.42%) and one case of carcinoma in situ. Of the five invasive adenocarcinomas, three were stage pT3. One case was stage pT2 and one case was stage pT1b. In all cases of invasive adenocarcinoma, there was a clinical suspicion of malignancy before or during surgery with detectable macroscopical abnormalities that encouraged the surgeon to send the gall bladder for histopathological examination. Conclusion: Invasive adenocarcinoma of the gallbladder is associated with detectable macroscopical abnormalities in all cases. Hence histopathological examination could be restricted to the macroscopically abnormal looking gall bladders. Such a selection will save time, cost and burden on the histopathologists without affecting the patients' safety.