Submitting the entire gallbladder in cases of dysplasia is not justified

When dysplasia is identified in a gallbladder, many experts recommend submission of the entire gallbladder for histologic examination. We sought to determine if this practice could be justified. We reviewed 16,611 gallbladder resections over an 8-year period, and identified 17 cases of carcinoma (15 primary and 2 metastatic), 9 cases of high-grade dysplasia, 16 cases of low-grade dysplasia, and 81 cases with atypia, not otherwise specified (NOS). Sixteen (94%) of 17 adenocarcinomas were identified and sampled on the initial gross inspection, and the remaining case was identified and sampled on review of the gross specimen. None of the high- or low-grade dysplasias were identified on gross examination, but all were identified as atypical on the initial slide submitted and correctly graded with the submission of 4 additional slides. Eight (89%) of 9 high-grade, 6 (38%) of 16 low-grade, and 1 (1%) of 81 atypia, NOS, cases were subsequently entirely submitted without identification of any new lesion. We conclude that for cases of dysplasia and atypia, NOS, review of the gross specimen and submission of up to 4 additional sections identify all significant lesions, and submission of the entire gallbladder is not justified.