AB090. SOH25_AB_167. Challenging the status quo: is routine histopathological examination necessary after all cholecystectomies?

Background: Routine histopathological examination of gallbladders after cholecystectomy is a standard practice to detect incidental gallbladder carcinoma (GBC), a rare malignancy with poor prognosis. While comprehensive, this approach may not be cost-effective or sustainable in low-incidence populations such as Ireland. This study evaluates the diagnostic yield of routine histopathology and explores the feasibility of a selective approach based on known risk factors of GBC, with potential benefits in cost and promoting sustainability in surgery.

Methods: A retrospective review of 935 gallbladder specimens submitted for histopathology over 5 years [2019–2023] at our institution was conducted. Clinical, imaging, and histopathological data were analysed to identify cases of GBC and associated risk factors. Cases of confirmed gallbladder carcinoma were reviewed in detail to identify clinical, radiological, and macroscopic predictors of malignancy.

Results: Two patients (0.21%) with GBC were identified. Both patients had risk factors, including age >50 years, gallbladder polyps (>1 cm), and abnormal imaging findings. None of the patients had macroscopically abnormal features intraoperatively. Our findings are consistent with international evidence supporting the use of selective histopathology for specimens with identifiable risk factors, reducing the workload and cost without compromising patient outcomes.

Conclusions: Given the low incidence of GBC in our population, adopting a selective approach to gallbladder histopathology is a safe and cost-effective alternative to routine examination. Such a protocol could reduce resource consumption, and energy use in pathology laboratories. As evidenced in Sweden and the Netherlands, this approach is implemented nationally, and a selective approach may maintain high diagnostic accuracy while optimizing resource utilization.

Keywords: Gallbladder carcinoma (GBC); cholecystectomy; histopathology; selective approach; sustainability