title: Selective histology of cholecystectomy specimens--is it justified?
abstract: BACKGROUND
  Gallbladder cancer (GBC) is rare but the most common malignancy of biliary tract with a dismal prognosis. The early diagnosis and surgical treatment of GBC offers the only chance of long-term survival. Despite advances in radiological imaging, early diagnosis of GBC is still rarely achieved without histopathology. In our hospital, routine histologic examination of all resected gallbladder specimens has been standard practice. This study seeks to define whether selective histologic examination for gallbladder specimens based on preoperative imaging or intraoperative findings is justified.
  
  
  METHODS
  From September 2008-September 2013, all histopathology reports of gallbladder specimens after elective cholecystectomy were retrospectively analyzed in a single surgical unit. Preoperative imaging, intraoperative findings, and histology notes were analyzed in all cases.
  
  
  RESULTS
  Out of 14,369 (60% female and 40% male) patients undergoing cholecystectomy, GBC was found in only 46 cases (0.32%). More than one fifth (10/46) of GBC patients presented with acute cholecutitis (AC). All 10 AC patients coexisted with GBC harbored "significantly inflamed' gallbladders, and about 83.49% AC patients were judged with "significant inflammation." Carcinoma in situ and early GBC (T1a, T1b) accounted for 61% of all cases. Only two patients with Tis and T1a respectively did not show suspicious lesion on preoperative and intraoperative findings, but for the remaining cases (44/46), GBC was suspected either by preoperative imaging and/or intraoperative findings.
  
  
  CONCLUSIONS
  Almost all cases of invasive GBC will show macroscopic abnormalities following examination by a simple procedure-a full dissection, inspection, and palpation of the gallbladder. Any patient with early GBCs "missed" on macroscopic examination can still receive the appropriate treatment by the cholecystectomy alone. The gallbladder should be sent for histology only if macroscopic examination raises suspicion. This selective policy is more cost-effective, and does not appear to compromise patients outcome.
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yi-lei
authors.initials: YL
authors.lastname: Deng
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xian-ze
authors.initials: XZ
authors.lastname: Xiong
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Anuj
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Fu-yu
authors.initials: FY
authors.lastname: Li
authors.affiliation: Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China. Electronic address: nanshengcheng2000@yeah.net.
authors.forename: Nan-sheng
authors.initials: NS
authors.lastname: Cheng
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy / Q000401:mortality*; D005260:Female; D005704:Gallbladder / Q000473:pathology / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010338:Pathology, Clinical / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Cholecystectomy; Gallbladder cancer; Histopathology