Does the postoperative diagnosis correlate with the final pathologic diagnosis in cholecystectomy?
Physicians diagnose cholecystitis using a variety of clinical signs and imaging modalities. Diagnoses are routinely confirmed with the gold-standard histopathological examination of the excised gallbladder. This study examines the correlation between the postoperative clinical diagnosis and postoperative pathology report findings. The clinical diagnosis of acute cholecystitis had a sensitivity of 58.8%, specificity of 75.2%, positive predictive value of 53.1%, and negative predictive value of 79.2% when compared to the final pathologic diagnosis. The clinical diagnosis of chronic cholecystitis agreed with the pathologic diagnosis of chronic cholecystitis in 45 of 54 cases (83.3%) but did not agree in 8 of 54 acute cases (14.8%); a clinical diagnosis of “symptomatic cholelithiasis” was associated with pathologic diagnosis of acute cholecystitis in 85 of 388 cases (21.9%). There was a statistically significant relationship between the clinical diagnosis and final pathologic diagnosis (chi-squared > 32.91, p-value <0.001). One incidental case of malignant neoplasm was found in a patient with gallstones. Surgeons made an accurate clinical diagnosis of acute cholecystitis in one third to one half of their surgical cases; they made an accurate clinical diagnosis of chronic cholecystitis 80% of the time and correctly diagnosed neoplasms in 3 out of 4 cases. These results suggest that the mismatch between the postoperative clinical diagnosis and postoperative pathology occurs frequently enough that pathologic assessment should occur routinely after cholecystectomy.
Copyright (c) 2022 Clarissa Ramirez, Ahmed Abdalla, Alikhan Karimi, Jasmin Rahesh, Hassan Ahmed, Muhammad Nazim
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All articles are published under the Creative Commons Attribution-Non-Commercial License https://creativecommons.org/licenses/by-sa/2.0/