Ruchir Mashar (West Bromwich / GB), Shaza Faycal MIrghani (West Bromwich / GB), Raveenjot Nagra (West Bromwich / GB), Michela Martinuzzi (West Bromwich / GB), Thomas Brookes (West Bromwich / GB), Qasim Mushtaq (West Bromwich / GB), Bernice Buraimoh (West Bromwich / GB), Pratik Bhattacharya (West Bromwich / GB)
Abstract text (incl. references and figure legends)
Introduction Routine histopathology is current practice following cholecystectomy in the UK, screening for incidental gallbladder carcinoma or its precursors. There are variations in practice globally, with the Netherlands recently adopting a selective approach, which includes macroscopic evaluation of the gallbladder specimen post extraction and subsequent selective histological analysis. The specimens are analysed for abnormalities indicating pre-malignant or malignant pathology. Many retrospective and prospective analyses exist to date, however none are randomised or blinded. We aim to evaluate our experience retrospectively as to whether selective histopathology is a safe approach
Material & Methods A retrospective analysis from June 2017 – June 2022 was conducted and histology reports from specimens from all patients who underwent cholecystectomy (elective, emergency, laparoscopic or open) were analysed, looking for the incidence of high grade dysplasia, polyps, carcinoma, or intracholecystic papillary neoplasm (ICPN). If any such lesions were found, their clinical course was evaluated further.
Results 23/2232 patients (0.01%) were found to have a positive finding: polyps (n = 13), high grade dysplasia (n = 1), ICPN (n = 2), carcinoma (n = 7). Of these, 16/23 (69.6%) had a pre-operative suspicision of a potential malignant diagnosis and hence would have been sent for histological analysis. Independently, 15/23 (65.2%) had abnormal macroscopic histology. If a selective approach was adopted, specimens would not have been sent in 4 cases and would have suffered the consequences of a lack of an earlier diagnosis and intervention.
Conclusions To justify any screening programme, certain criteria need to be met, with screening for gallbladder malignancy failing to meet these. A double-blinded randomised multi-centre study may elucidate the use of selective histopathology as a more economically efficient screening tool, without adverse clinical outcomes.
References
Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)
No