Incidental lesions in appendectomy specimens: Rare or rarely sampled?

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.