Abstract
Background
Despite the increasing implementation of selective histopathologic policies for post-cholecystectomy
evaluation of gallbladder specimens in low-incidence countries, the fear of missing
incidental gallbladder cancer (GBC) persists. This study aimed to develop a diagnostic
prediction model for selecting gallbladders that require additional histopathological
examination after cholecystectomy.
Methods
A registration-based retrospective cohort study of nine Dutch hospitals was conducted
between January 2004 and December 2014. Data were collected using a secure linkage
of three patient databases, and potential clinical predictors of gallbladder cancer
were selected. The prediction model was validated internally by using bootstrapping.
Its discriminative capacity and accuracy were tested by assessing the area under the
receiver operating characteristic curve (AUC), Nagelkerke's pseudo-R2, and Brier score.
Results
Using a cohort of 22,025 gallbladders, including 75 GBC cases, a prediction model
with the following variables was developed: age, sex, urgency, type of surgery, and
indication for surgery. After correction for optimism, Nagelkerke's R2 and Brier score were 0.32 and 88%, respectively, indicating a moderate model fit.
The AUC was 90.3% (95% confidence interval, 86.2%–94.4%), indicating good discriminative
ability.
Discussion
We developed a good clinical prediction model for selecting gallbladder specimens
for histopathologic examination after cholecystectomy to rule out GBC.
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References
- Global epidemiological trends and variations in the burden of gallbladder cancer.J Surg Oncol. 2017; 115: 580-590
- Surgical treatment of 724 carcinomas of the gallbladder. Results of the French surgical association survey.Ann Surg. 1994; 219: 275-280
- Gallbladder carcinoma in the United States: a population based clinical outcomes study involving 22 343 patients from the surveillance, epidemiology, and end result database (1973–2013).HPB Surg. 2017; 20171532835
- Primary carcinoma of the gallbladder.Surg Gynecol Obstet. 1978; 147: 929-942
- Surgical treatment of 724 carcinomas of the gallbladder. Results of the French surgical association survey.Ann Surg. 1994; 219: 275-280
- Genetic landscape of gallbladder cancer: global overview.Mutat Res/Rev Mutat. 2018; 778: 61-71
Cancer Research the Netherlands http://www.cijfersoverkanker.nl/.
- Should all gallbladders be examined routinely or selectively by microscopy after cholecystectomy? Population-based Dutch study over a decade.Br J Surg. 2021; 108: 131-132
- Routine histological analysis of a macroscopically normal gallbladder. A review of the literature.Int J Surg. 2014; 12: 958-962
- Safe, selective histopathological examination of gallbladder specimens: a systematic review.Br J Surg. 2020; 107: 1414-1428
- ‘Routine’ pathological examination of the gallbladder is a futile exercise.Br J Surg. 1998; 85: 208
- Selective histological examination after cholecystectomy: an analysis of current daily practice in The Netherlands.World J Surg. 2019; 43: 2561-2570https://doi.org/10.1007/s00268-019-05077-w
- Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement.BMJ. 2015; 350: g7594https://doi.org/10.1136/bmj.g7594
- Clinical prediction models.Springer, New York, NY2009
- Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease: results from a population-based gallstone surgery registry.Surgery. 2017; 162 (256–26)
- Simulation study of the number of events per variable in logistic regression analysis.J Clin Epidemiol. 1996; 49: 1373-1379
- Completeness of cancer registration in Limburg, The Netherlands.Int J Epidemiol. 1993; 22 (369–6)
- Stepwise selection in small data sets: a simulation study of bias in logistic regression analysis.J Clin Epidemiol. 1999; 52: 935-942
- Laparoscopic cholecystectomy does not demonstrably decrease survival of patients with serendipitously treated gallbladder cancer.J Am Coll Surg. 2001; 192: 189-195
- Incidentally detected gallbladder cancer- the controversies and algorithmic approach to management.Indian J Surg. 2012; 74: 248-254
- Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience.Arch Surg. 2009; 144: 441-447
- Incidental gallbladder cancer at cholecystectomy: when should the surgeon Be suspicious?.Ann Surg. 2014; 260: 128-133
- The meaning and use of the area under a receiver operating characteristic (ROC) curve.Radiology. 1982; 143: 29-36https://doi.org/10.1148/radiology.143.1.7063747
- Understanding diagnostic tests 1: sensitivity, specificity and predictive values.Acta Paediatr. 2007; 96: 338-341https://doi.org/10.1111/j.1651-2227.2006.00180.x
- Communicating accuracy of tests to general practitioners: a controlled study.BMJ. 2002; 324: 824-826
- Method for adequate macroscopic gallbladder examination after cholecystectomy.Acta Chir Belg. 2020; 120: 442-450
- Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified.Eur J Surg Oncol. 2019; 46: 572-576https://doi.org/10.1016/j.ejso.2019.11.497
- Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder.World J Gastroenterol. 2011; 17: 2216-2222
- Comparison of surgically resected polypoid lesions of the gallbladder to their pre-operative ultrasound characteristics.J Gastrointest Surg. 2009; 13: 19-25
- Mirizzi syndrome and gallbladder cancer.J Hepato-Biliary-Pancreatic Surg. 2006; 13: 323-326
- High coincidence of Mirizzi syndrome and gallbladder carcinoma.Surgery. 1997; 121: 58-63
- Cancer surveillance in patients with primary sclerosing cholangitis.Hepatology. 2011; 54: 1842-1852
- Primary sclerosing cholangitis, Part 2: cancer risk, prevention, and surveillance.J Gastroenterol Hepatol. 2018; 14: 427-432
- Early gallbladder carcinoma associated with primary sclerosing cholangitis and ulcerative colitis.J Gastroenterol. 2003; 38: 704-706
- Reassessing the need for prophylactic surgery in patients with porcelain gallbladder: case series and systematic review of the literature.Arch Surg. 2011; 146: 1143-1147
- Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination.Dig Surg. 2013; 30: 472-475
- Routine pathology and postoperative follow-up are not cost effective in cholecystectomy for benign gallbladder disease.World J Surg. 2018; 42: 3165-3170
- Outcome of surgical inspection of the gallbladder in relation to final pathology.J Gastrointest Surg. 2019; 23: 1130-1134
Article info
Publication history
Published online: November 15, 2022
Accepted:
November 14,
2022
Received:
March 30,
2022
Publication stage
In Press Uncorrected ProofFootnotes
This paper was selected for a poster presentation at the 15th Congress of the International Hepato-Pancreato-Biliary Association (March 30–April 2 2022, New York, United States).
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of International Hepato-Pancreato-Biliary Association Inc.
