Abstract
Previous studies have shown that uniform pathologic review of all splenectomy surgical specimens reveals new clinically actionable diagnoses only in a minority of cases. To examine whether the aggregate of clinical, laboratory, imaging, and pathologic preoperative data is associated with a clinically beneficial pathologic study for routine splenectomy surgical specimens. This single-center retrospective cohort study included all patients who underwent splenectomy from January 1, 2013, through December 31, 2018, at a single center. Clinical, imaging, and pathologic data were extracted from the institution's electronic medical records system. Data analysis was conducted from June to November 2020. Undergoing splenectomy for trauma or diagnostic or therapeutic indications. Spleen pathology study resulting in a new medical diagnosis or change in medical management. Overall, 90 patients (53 [59%] men) with a median (range) age of 59 (19-90) years underwent splenectomy for therapeutic purposes in 41 patients (45%), trauma in 24 patients (27%), diagnostic purposes in 15 patients (17%), and combined therapeutic and diagnostic purposes in 9 patients (10%). In 14 patients (15%) a new malignant neoplasm was found, and in 8 patients (9%), a new nonneoplastic medical condition was diagnosed. A new pathologic diagnosis resulted in change in medical management in 16 patients (18%). In patients without a prior diagnosis of cancer, 41 of 56 pathology biopsies (73%) were found to be normal whereas in 7 biopsies (13%), a new diagnosis of a hematologic malignant neoplasm was revealed (P < .001). Patients with clinical splenomegaly were significantly more likely to have a new pathologic diagnosis of cancer compared with patients without splenomegaly (15 of 26 [58%] vs 4 of 64 [7%]; P < .001). In 39 of 43 patients (91%) with normal presurgery imaging studies, normal spleen pathology was revealed, whereas in 14 of 17 patients (82%) with abnormal imaging studies, a new hematological malignant neoplasm was diagnosed following pathologic review of the spleen specimen (P < .001). Patients with gross abnormalities on macroscopic examination had a significantly increased likelihood of a hematological cancer diagnosis (17 of 40 [43%]) and a solid cancer diagnosis (4 [10%]) compared with patients with grossly normal specimens (4 of 49 [8%]; P < .001). In this cohort study, routine pathologic review of spleen specimens was clinically beneficial in patients with splenomegaly, abnormal imaging results, a prior diagnosis of cancer, and with grossly abnormal spleens.
Highlights
A nearly universal dictum of medical care is that all specimens removed during surgery are routinely sent to pathological review with the intent of finding a new previously undiagnosed medical condition
A new pathologic diagnosis resulted in change in medical management in 16 patients (18%)
Patients with gross abnormalities on macroscopic examination had a significantly increased likelihood of a hematological cancer diagnosis (17 of 40 [43%]) and a solid cancer diagnosis (4 [10%]) compared with patients with grossly normal specimens (4 of 49 [8%]; P < .001). In this cohort study, routine pathologic review of spleen specimens was clinically beneficial in patients with splenomegaly, abnormal imaging results, a prior diagnosis of cancer, and with grossly abnormal spleens
Summary
A nearly universal dictum of medical care is that all specimens removed during surgery are routinely sent to pathological review with the intent of finding a new previously undiagnosed medical condition. In patients undergoing diagnostic splenectomy, typically for the workup of splenomegaly or discrete mass lesions of the spleen, much higher rates of a new pathologic diagnosis are established, with lymphoma being a predominant etiology.. In patients undergoing diagnostic splenectomy, typically for the workup of splenomegaly or discrete mass lesions of the spleen, much higher rates of a new pathologic diagnosis are established, with lymphoma being a predominant etiology.2,6-9 Owing to these data, the practice of routine uniform pathology review of all surgical spleen specimens has been questioned. The specific patient segment that would benefit the most from routine pathology review of splenectomy specimens has not been precisely defined In this analysis of 90 consecutive splenectomies, we sought to define clinical, laboratory, and imaging results associated with the diagnosis of a new medical condition or with a change in medical management
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