A different perspective on macroscopic sampling of cholecystectomy specimens

Abstract

Background: Because there may be interdepartmental differences in macroscopic sampling of cholecystectomy specimens, we aimed to investigate differences between the longitudinal sampling technique and our classical sampling technique in cholecystectomy specimens in which there was no obvious malignancy.

Methods: Six hundred eight cholecystectomy specimens that were collected between 2011 and 2012 were included in this study. The first group included 273 specimens for which one sample was taken from each of the fundus, body, and neck regions (our classical technique). The second group included 335 specimens for which samples taken from the neck region and lengthwise from the fundus toward the neck were placed together in one cassette (longitudinal sampling). The Pearson chi-square, Fisher exact, and ANOVA tests were used and differences were considered significant at p<.05.

Results: In the statistical analysis, although gallbladders in the first group were bigger, the average length of the samples taken in the second group was greater. Inflammatory cells, pyloric metaplasia, intestinal metaplasia, low grade dysplasia, and invasive carcinoma were seen more often in the second group.

Conclusions: In our study, the use of a longitudinal sampling technique enabled us to examine a longer mucosa and to detect more mucosal lesions than did our classical technique. Thus, longitudinal sampling can be an effective technique in detecting preinvasive lesions.

Keywords: Cholecystectomy; Incidental gallbladder cancer; Longitudinal sampling technique; Preinvasive lesions; Swiss-roll method.

Fig. 1

Our classical technique: one sample is taken from each of the fundus, body, and neck/cystic duct regions and all samples are all placed in one cassette.

Fig. 2

The longitudinal sampling technique: a sample taken from the neck region and another sample taken lengthwise from the fundus toward the neck (the latter rolled with the "swiss-roll" method) are placed together in one cassette.

Fig. 3

In some specimens, mucosal yellow flecks are seen and these flecks lay side by side and formed linear striations which run parallel to the long axis of the specimen.