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Incidental lesions in appendectomy specimens: Rare or rarely sampled?
Nuray Kepil1, Sebnem Batur1, Ozan Akinci2
1Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
Objective:
During the microscopic examination of the specimens after appendectomy operations performed due to acute appendicitis, pathologists may encounter some incidental and unusual lesions. Appendectomy specimens are sampled as 3 sections/1 paraffin block in many centers. In this study, we aimed to evaluate whether multiple and dense sampling of appendix specimens has an impact on the incidence of incidental lesions of the appendix.
Methods:
This study is a retrospective study of 1154 patients who underwent appendectomy with presumed acute appendicitis at the Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, had histopathological evaluation between 2007-2011 and 2014-2018. Group 1 was made up of the patients whose appendix specimens were examined as 3 sections/1 paraffin block. Group 2 was made up of the patients whose appendix specimens were sampled completely. In this study, it was evaluated whether there was a difference between the two groups concerning incidence of incidental benign and malign appendix lesions.
Results:
There were 579 patients in Group 1, 575 patients in Group 2, and the mean age of the groups was 26 and 28, respectively. Neither acute appendicitis findings nor any of the other unusual lesions were found in 57 specimens (9.8%) in Group 1 and 58 specimens (10.1%) in Group 2. Unusual pathological findings were detected in six specimens in Group 1 and 21 in Group 2. All unusual lesions, including benign and malignant, were significantly higher in Group 2 than in Group 1 (p=0.013). Concerning the incidence of malignant incidental lesions alone, there was no significant difference between the two groups (p=0.136).
Conclusion:
Multiple and dense sampling of appendectomy specimens increases the likelihood of detecting unusual lesions of the appendix.
Insights
Comprehensive sampling of appendix specimens during appendectomy significantly increases the detection of unusual lesions. This enhanced pathological examination aids in identifying both benign and malignant incidental findings.
Area of Science:
- Pathology
- Surgical Pathology
- Gastrointestinal Pathology
Background:
- Appendectomy is commonly performed for acute appendicitis.
- Incidental and unusual lesions may be discovered during microscopic examination of appendectomy specimens.
- Standard sampling methods involve examining 3 sections per paraffin block.
Purpose of the Study:
- To investigate the impact of multiple and dense sampling of appendix specimens on the incidence of incidental lesions.
- To compare the detection rates of unusual appendix lesions between standard and complete sampling methods.
Main Methods:
- Retrospective analysis of 1154 patients undergoing appendectomy for presumed acute appendicitis.
- Group 1: Appendix specimens examined using standard 3 sections/1 paraffin block method.
- Group 2: Appendix specimens sampled completely for examination.
Main Results:
- Complete sampling (Group 2) revealed a significantly higher incidence of all unusual lesions (benign and malignant) compared to standard sampling (Group 1) (p=0.013).
- No significant difference in the incidence of malignant incidental lesions alone was observed between the two groups (p=0.136).
- Incidental lesions were found in 9.8% of Group 1 and 10.1% of Group 2 specimens.
Conclusions:
- Multiple and dense sampling of appendectomy specimens enhances the detection of unusual appendix lesions.
- Complete sampling may improve the identification of incidental benign pathologies.
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