Clarissa Ramirez MD, MBA, Ahmed Abdalla MD, Alikhan Karimi MD, Jasmin Rahesh MBA, MS, Brianna Taylor BS, Hassan Ahmed MD, MRCSI, Muhammad Nazim MD
Physicians diagnose cholecystitis using a variety of clinical signs and imaging modalities. Diagnoses are routinely confirmed with the gold-standard histopathological examination of the excised gallbladder. This study examines the correlation between the postoperative clinical diagnosis and postoperative pathology report findings. The clinical diagnosis of acute cholecystitis had a sensitivity of 58.8%, specificity of 75.2%, positive predictive value of 53.1%, and negative predictive value of 79.2% when compared to the final pathologic diagnosis. The clinical diagnosis of chronic cholecystitis agreed with the pathologic diagnosis of chronic cholecystitis in 45 of 54 cases (83.3%) but did not agree in 8 of 54 acute cases (14.8%); a clinical diagnosis of “symptomatic cholelithiasis” was associated with pathologic diagnosis of acute cholecystitis in 85 of 388 cases (21.9%). There was a statistically significant relationship between the clinical diagnosis and final pathologic diagnosis (chi-squared >32.91, p-value <0.001). One incidental case of malignant neoplasm was found in a patient with gallstones. Surgeons made an accurate clinical diagnosis of acute cholecystitis in one third to one half of their surgical cases; they made an accurate clinical diagnosis of chronic cholecystitis 80% of the time and correctly diagnosed neoplasms in 3 out of 4 cases. These results suggest that the mismatch between the postoperative clinical diagnosis and postoperative pathology occurs frequently enough that pathologic assessment should occur routinely after cholecystectomy.
Keywords: acute cholecystitis, chronic cholecystitis, cholelithiasis, pathological diagnosis
Article citation: Ramirez C, Abdalla A, Karimi A, Rahesh J, Taylor B, Ahmed H, Nazim M. Does the postoperative diagnosis correlate with the final pathologic diagnosis in cholecystectomy? The Southwest Respiratory and Critical Care Chronicles 2022;10(44):10–14
From: Baylor College of Medicine Department of Anesthesiology (CR), Houston, Texas; Albert Einstein Medical Center, Department of Urology (AA), Philadelphia, PA; Baylor Scott & White Med Center (AK), Temple, Texas; Texas Tech University Health Sciences Center School of Medicine Department of Surgery (JR, BT, MN), Lubbock, Texas; Case Western Reserve University Department of Surgery (AH), Cleveland, Ohio
Submitted: 12/20/2021
Accepted: 5/10/2022
Conflicts of interest: none
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