Usefulness of histopathologic study of appendectomy and cholecystectomy specimens Utilidad del estudio histopatológico de especímenes de apendicectomía y colecistectomía

Introduction: Recent evidence shows that microscopic examination of some surgical specimens is not necessary. The aim of this work was to assess the usefulness of routine histopathological examination of appendectomy and cholecystectomy specimens, and its impact on the management of patients. Methods: We reviewed all pathological reports on appendectomy and cholecystectomy specimens studied in our laboratory between January 2008 and July 2009. The frequency of unexpected pathological diagnoses and their impact on management of patients were evaluated. Results: Out of 2.175 appendectomy specimens, 40 (1.8%) revealed unexpected pathological findings, mostly parasitic infestations (23 cases). Apart from parasites, there were only 2 cases with impact on management: one of tuberculosis and another of a mucinous borderline cystadenoma. Unexpected pathological gallbladder findings were present in 14 (1.3%) of 1.039 cholecystectomy specimens: 2 were of in situ carcinoma and 12 of invasive carcinoma; 8 cases with treatment implications had not been suspected by the surgeons, and 4 of them were not evident in the macroscopic examination. Conclusions: Incidental histological findings that are relevant to the management of patients are rare but, nevertheless, they indicate that microscopic examination is necessary. Since routine studies are expensive, a more selective approach to histological studies could be proposed. Introducción: trabajos recientes indican que en algunos especímenes quirúrgicos se puede omitir el estudio microscópico. El objetivo del presente estudio fue evaluar la utilidad del estudio histopatológico rutinario de apéndices cecales y vesículas biliares y determinar su impacto en el tratamiento posterior del paciente. Métodos: revisamos todos los informes anatomopatológicos de apendicectomías y colecistectomías en nuestro laboratorio entre enero de 2008 y julio de 2009. Determinamos la frecuencia de diagnósticos inesperados y su impacto en el tratamiento del paciente. Resultados: de 2.175 especímenes de apendicectomía, 40 (1,8%) tuvieron diagnósticos inesperados, la mayoría de ellos infestación por parásitos (23 casos). Aparte de estos, hubo solo dos casos con impacto en el tratamiento: uno de tuberculosis y otro de cistadenoma mucinoso limítrofe (borderline). Entre 1.039 colecistectomías en 14 (1,3%) hubo hallazgos inesperados: 2 carcinomas in situ y 12 carcinomas invasores; 8 de los casos con implicaciones para el tratamiento no fueron sospechad