The value of routine histopathological examination after haemorrhoidectomy in patients at low and high risk of anal squamous intraepithelial lesions and cancer

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-03-17 DOI:10.1111/codi.70056

Panuwat Pornkul, Guy Lampe, Renae Bertucci, Shehan Wickramasinghe, Kerenaftali Klein, Chrispen Mushaya, Shinichiro Sakata

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引用次数: 0

Abstract

Aim

Routine histopathological evaluation of haemorrhoidectomy specimens is not ubiquitous amongst surgeons as its utility is debatable. This is the first study to assess the detection rate of anal squamous intraepithelial lesions (aSIL) and anal squamous cell carcinoma (aSCC) in low- and high-risk patients.

Method

This 9-year retrospective study assessed electronic medical records of all patients who underwent excisional haemorrhoidectomy within an Australian tertiary referral hospital. Patients with sinister clinical examination findings were excluded from the study. Data collected included patient demographics, pertinent history, relevant risk factors, histopathology reports and digital rectal examination findings. Cost–benefit analysis of routine pathology submission and a city-wide survey of surgeons to ascertain current practices were also undertaken.

Results

The overall prevalence of incidental aSIL and aSCC was 27 (8.1%); 19 patients (5.7%) had low-grade squamous intraepithelial lesions (LSILs), seven (2.1%) had high-grade squamous intraepithelial lesions (HSILs) and one patient (0.3%) had aSCC. More than three out of four were detected in low-risk patients, with most cases being LSIL. Comparing low-risk and high-risk patients, the observed incidental detection rate of aSIL and aSCC was 6.8% (95% CI 4.49–10.17) and 23.1% (95% CI 11.03–52.05), respectively. Multivariate logistic regression showed a large, significant association between high-risk risk factors and detecting aSIL and aSCC (OR 3.76, 95% CI 1.32–10.68, P = 0.013). A city-wide survey of surgeons demonstrated that 28.6% do not request routine histopathological evaluation and 64.3% thought that the prevalence of sinister incidental pathology in haemorrhoids was 1% or less. The total cost of conducting routine histopathological evaluation per patient was $96.80 AUD ($59.20 EUR, $65.30 USD).

Conclusion

Given the non-negligible incidental detection rate of aSIL and aSCC in both low-risk and high-risk patients, coupled with the cost-effectiveness of histopathological examination, this study suggests that routine histopathological examination should not be restricted solely to high-risk patients. Further study of the benefit of surveillance following clinical detection in low- and high-risk patients is needed.

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痔切除术后常规组织病理学检查在肛门鳞状上皮内病变和癌的低、高风险患者中的价值

目的痔切除术标本的常规组织病理学评估在外科医生中并不普遍，因为它的效用是有争议的。这是第一个评估肛门鳞状上皮内病变（aSIL）和肛门鳞状细胞癌（aSCC）在低高危患者中的检出率的研究。方法回顾性分析澳大利亚某三级转诊医院所有痔切除术患者的电子病历。有不良临床检查结果的患者被排除在研究之外。收集的资料包括患者人口统计学、相关病史、相关危险因素、组织病理学报告和直肠指检结果。还对常规病理报告进行了成本效益分析，并对全市外科医生进行了调查，以确定目前的做法。结果偶发aSIL和aSCC的总患病率为27例（8.1%）；19例（5.7%）为低级别鳞状上皮内病变（LSILs）， 7例（2.1%）为高级别鳞状上皮内病变（HSILs）， 1例（0.3%）为aSCC。在低风险患者中检测到超过四分之三的病例，其中大多数为低级别sil。低危和高危患者比较，aSIL和aSCC的意外检出率分别为6.8% （95% CI 4.49 ~ 10.17）和23.1% （95% CI 11.03 ~ 52.05）。多因素logistic回归分析显示，高危因素与aSIL和aSCC检测之间存在显著相关性（OR 3.76, 95% CI 1.32-10.68, P = 0.013）。一项全市范围的外科医生调查显示，28.6%的外科医生不要求常规的组织病理学评估，64.3%的外科医生认为痔疮的恶性附带病理发生率在1%或以下。每位患者进行常规组织病理学评估的总费用为96.80澳元（59.20欧元，65.30美元）。结论考虑到aSIL和aSCC在低风险和高危患者中的意外检出率不可忽视，再加上组织病理学检查的成本-效果，本研究提示常规组织病理学检查不应仅限于高危患者。需要进一步研究低危和高危患者临床检测后监测的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.