Safety and cost of selective histopathological analysis for detecting cancer in surgical specimens: a systematic review

Background: Due to limited healthcare resources, there is global incentive to maximize efficacy while minimizing patient harm. Given the low rate of cancer diagnoses made via routine histopathological analysis of surgical specimens, a selective approach has been proposed as a viable alternative. This systematic review aimed to evaluate effectiveness of cancer detection and costs with a selective approach.

Methodology: This study was registered with PROSPERO (CRD42022346535) and conducted according to PRISMA 2020 and MOOSE guidelines. Ovid Embase, Ovid MEDLINE and PubMed were searched from earliest result (1973) to 30 July 2022 for studies evaluating selective histopathology for surgical specimens. Screening, risk of bias assessment and data extraction were completed in duplicate. Statistical analysis used a random effects model.

Results: Searches identified 4194 records, with 11 studies included consisting of 26 126 patients. Eight studies analysed patients who underwent cholecystectomy while three analysed patients who underwent appendectomy, vertical laparoscopic sleeve gastrectomy and neurectomy. In total, 295 neoplasms were detected: 196 malignant, 99 benign. Overall mean proportion of malignant neoplasms is 0.01 (95% confidence interval 0.00, 0.01). Weighted mean projected cost savings were calculated in varying formats, ranging from 6891 Euros per year within one hospital, 712 748 Euros per 10 000 patients, to 875 077 Euros per year within one country.

Conclusion: A selective approach is not associated with a significant proportion of missed cancer diagnoses, and provides considerable cost savings, particularly demonstrated for cholecystectomy samples. Further discussion is required regarding how surgeons will be protected medicolegally without the safety net of routine analysis.