Safe, Selective Histopathological Examination Of Gallbladder Specimens: A Systematic Review

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 center dot 32 (95 per cent c.i. 0 center dot 25 to 0 center dot 42) per cent for incidental GBC and 0 center dot 18 (0 center dot 10 to 0 center dot 35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0 center dot 04 (0 center dot 01 to 0 center dot 14) per cent. In high-incidence countries, corresponding pooled incidences were 0 center dot 83 (0 center dot 58 to 1 center dot 18), 0 center dot 44 (0 center dot 21 to 0 center dot 91) and 0 center dot 08 (0 center dot 02 to 0 center dot 39) per cent respectively. Clinical consequences were reported for 176 (39 center dot 3 per cent) of 448 patients with truly incidental GBC. Thirty-three patients (18 center dot 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.