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DOI: 10.5146/tjpath.2017.01404
A Retrospective Evaluation of the Epithelial Changes/Lesions and Neoplasms of the Gallbladder in Turkey and a Review of the Existing Sampling Methods: A Multicentre Study
Güldal Esendağlı1, F. Göknur Akarca1, Serdar Balcı2, Asuman Argon3, Selma Şengiz Erhan4, Nesrin Turhan5, Neslihan İnce Zengin5, Sevinç Hallaç Keser6, Betül Çelik7, Tangül Bulut7, Samir Abdullazade8, Esra Erden9, Berna Savaş9, Temmuz Bostan9, Özgül Sağol10, Anıl Aysal Ağalar10, Nuray Kepil11, Yıldırım Karslıoğlu12, Armağan Günal12, Fatma Markoç13, Burcu Saka14, Gonca Özgün15, Şükrü Oğuz Özdamar16, Burak Bahadır16, Esin Kaymaz16, Emre Işık16, Semin Ayhan17, Deniz Tunçel18, Banu Özgüven Yılmaz18, Sevinç Çelik19, Tuba Karabacak20, İpek Erbarut Seven21, Çiğdem Ataizi Çelikel21, Zuhal Gücin22, Özgür Ekinci1, Gülen Akyol1
1Department of Medical Pathology, Gazi University School of Medicine, Ankara, Turkey
2Department of Medical Pathology, Ankara University Yıldırım Beyazıt School of Medicine, Ankara, Turkey
3Department of Pathology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
4Department of Pathology, Okmeydani Training and Research Hospital, Istanbul, Turkey
5Department of Pathology, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey
6Department of Pathology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
7Department of Pathology, Department of Medical Pathology, University of Health Science, Antalya Training and Research Hospital, Antalya, Turkey
8Department of Pathology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
9Department of Medical Pathology, Ankara University School of Medicine, Ankara, Turkey
10Department of Medical Pathology, Dokuz Eylül University School of Medicine, Izmir, Turkey
11Department of Medical Pathology, İstanbul University, Cerrahpaşa School of Medicine, Istanbul, Turkey
12Department of Pathology, Gülhane Training and Research Hospital, Ankara, Turkey
13Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
14Department of Pathology, Istanbul University Medipol School of Medicine, Istanbul, Turkey
15Department of Medical Pathology, Başkent University School of Medicine, Ankara, Turkey
16Department of Medical Pathology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
17Department of Medical Pathology, Celal Bayar University School of Medicine, Manisa, Turkey
18Department of Medical Pathology, Department of Pathology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
19Department of Medical Pathology, Bozok University School of Medicine, Yozgat, Turkey
20Department of Medical Pathology, Mersin University School of Medicine, Mersin, Turkey
21Department of Pathology, Marmara University School of Medicine, Pendik Training and Research Hospital, İstanbul, Turkey
22Department of Medical Pathology, Bezmialem Foundation University School of Medicine, İstanbul, Turkey
Keywords: Gallbladder, Cholecystectomy, Dysplasia, Neoplasia, Sampling

Objective: As there is continuing disagreement among the observers on the differential diagnosis between the epithelial changes/lesions and neoplasms of the gallbladder, this multicentre study was planned in order to assess the rate of the epithelial gallbladder lesions in Turkey and to propose microscopy and macroscopy protocols.

Material and Method: With the participation of 22 institutions around Turkey that were included in the Hepato-Pancreato-Biliary Study Group, 89,324 cholecystectomy specimens sampled from 2003 to 2016 were retrospectively evaluated. The numbers of adenocarcinomas, dysplasias, intracholecystic neoplasms/adenomas, intestinal metaplasias and reactive atypia were identified with the review of pathology reports and the regional and countrywide incidence rates were presented in percentages.

Results: Epithelial changes/lesions were reported in 6% of cholecystectomy materials. Of these epithelial lesions, 7% were reported as adenocarcinoma, 0.9% as high-grade dysplasia, 4% as low-grade dysplasia, 7.8% as reactive/regenerative atypia, 1.7% as neoplastic polyp, and 15.6% as intestinal metaplasia. The remaining lesions (63%) primarily included non-neoplastic polypoids/hyperplastic lesions and antral/pyloric metaplasia. There were also differences between pathology laboratories.

Conclusion: The major causes of the difference in reporting these epithelial changes/lesions and neoplasms include the differences related to the institute's oncological surgery frequency, sampling protocols, geographical dissimilarities, and differences in the diagnoses/interpretations of the pathologists. It seems that the diagnosis may change if new sections are taken from the specimen when any epithelial abnormality is seen during microscopic examination of the cholecystectomy materials.


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