Is routine histopathological examination of dacryocystorhinostomy/dacryocystectomy specimens necessary? A tertiary...

Limited literature documenting the incidence of unsuspected malignant neoplasm among dacryocystorhinostomy/Dacryocystectomy (DCR/DCT) specimens is reviewed to determine if routine biopsy of all the patients undergoing such procedures is required. We are evaluating if sending lacrimal sac specimens for histopathological examination is necessary as a routine patient's care standard.

This is a retrospective study of all lacrimal sac specimens received for histopathological examination in a tertiary eye hospital over a period of 12 years.

This is an institutional study of all patients who underwent lacrimal sac drainage procedure and/or lacrimal sac biopsy during the 12-years period.

498 samples from 459 patients were included for review of the histopathological findings and tissue diagnosis. The files were checked for demographic data collection, preoperative clinical diagnosis and suspicion of malignancy.

Out of the 459 patients initially included, the mean age was 51.63 ± 17.8 years. Female patients constituted 70.8% while male patients accounted for 29.2%. Malignancy was suspected before surgery in 3 cases of the 498 specimens reviewed (0.6%). The remaining 495 specimens analyzed, 17 cases (3.43%) had unsuspected tissue diagnosis (other than chronic dacryocystitis) including Oncocytoma in 7, dacryolith in 7 and granulomas in 3. However, no case of malignant neoplasm was identified.

There were no unsuspected malignant cases in the current series. Therefore routine histopathological examination of DCR specimens is not considered to be essential. It should be reserved only for selected suspicious cases. Careful intra-operative assessment in these cases is also warranted.