Is there need of routine histopathological analysis of cholecystectomy specimens.

Abstract

Objective: To determine the prevalence of incidental gallbladder carcinoma (GBC) and premalignant lesions in routine histopathological examination (HPE) of all cholecystectomy specimens at a tertiary-care hospital in Karachi. Study Design: Prospective Cohort study. Setting: Kulsoom Bai Valika Hospital. Period: April 2024 to April 2025. Methods: All adult patients (≥18 years) undergoing elective or emergency cholecystectomy were enrolled. Exclusions comprised preoperatively known or suspected GBC and lost specimens. Demographic, clinical, ultrasonographic, operative, and histopathological data were collected on 600 patients. Specimens underwent standard paraffin embedding, sectioning, and hematoxylin-eosin staining. Histological diagnoses were classified into chronic cholecystitis (with/without stones), acute cholecystitis, cholesterolosis, adenomyomatosis, adenoma, metaplasia (intestinal/pyloric), xanthogranulomatous cholecystitis, high-grade dysplasia/carcinoma in situ, and invasive carcinoma (staged T1a/T1b). Continuous variables are presented as mean ± SD; categorical variables as n (%). Group comparisons used Student’s t-test or chi-square/Fisher’s exact tests; p < 0.05 was significant. Results: Among 600 patients (344 elective, 256 emergency; mean age 48.0 ± 12.0 years; 72.7% female), chronic cholecystitis was predominant (411/600, 68.5%). Acute cholecystitis occurred in 107 (17.8%). Benign neoplasms and non-neoplastic lesions were infrequent: adenoma 0.8%, adenomyomatosis 3.8%, cholesterolosis 1.7%, cholesterol polyps 1.0%, and metaplasia 2.8%. High-grade dysplasia/carcinoma in situ was identified in 12 (2.0%). Incidental invasive GBC was found in 6 elective patients (1.0%; all T1 lesions). No carcinomas were detected in emergency cases. Emergency surgery was associated with higher white blood cell counts (14.65 ± 2.94 vs. 8.02 ± 2.93 × 10^9/L; p < 0.001) and fever (61.3% vs. 0%; p < 0.001). Conclusion: Routine HPE of all cholecystectomy specimens in this high-incidence setting identified early-stage GBC and premalignant lesions in a meaningful proportion (3.0%), justifying universal submission. Selective protocols risk missing occult neoplasia and should be applied cautiously in similar populations.