title: Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: a systematic review.
abstract: BACKGROUND
  Routine histopathological examination of gallbladder specimens is mainly performed to identify unexpected gallbladder carcinoma (GBC). This systematic review assesses the prevalence and characteristics of GBC in cholecystectomy specimens.
  
  
  METHODS
  PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for all articles reporting on the finding of GBC in cholecystectomy specimens.
  
  
  RESULTS
  Of the 30 articles included, 20 were from Europe and the United States, and 10 were of Asian origin. In the Western studies, 276 cases of GBC were found in 61,542 specimens (median prevalence 0.4%, 95% confidence interval [CI] 0.3-0.6). Of these, 65% were expected pre- or intraoperatively. In the Asian studies, 344 cases of GBC were found in 37,365 specimens (median prevalence 1.2%, 95% CI 0.8-1.7). Of these, 45% were expected pre- or intraoperatively. In a subgroup analysis, identification of previously unexpected GBC affected treatment in only a minority of patients. In total, 72% of the patients received no further treatment and 32 patients (22%) received secondary surgery, of whom 15 patients survived at least 1 year.
  
  
  CONCLUSIONS
  The histopathological finding of GBC after cholecystectomy appears to be a rare event. The prevalence of unexpected GBC was higher in Asian studies than in Western studies. The pre- and intraoperative sensitivity for this carcinoma is low. Moreover, the diagnosis of GBC at the time of histopathology is usually inconsequential. The results of this systematic review do not support routine histopathology of cholecystectomy specimens in clinical practice.
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands, h.a.swank@amc.uva.nl.
authors.forename: Hilko A
authors.initials: HA
authors.lastname: Swank
authors.forename: Irene M
authors.initials: IM
authors.lastname: Mulder
authors.forename: Wim C
authors.initials: WC
authors.lastname: Hop
authors.forename: Marc J
authors.initials: MJ
authors.lastname: van de Vijver
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D002763:Cholecystectomy; D003581:Cytodiagnosis; D005704:Gallbladder / Q000473:pathology* / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D011184:Postoperative Period