Is routine histopathological examination of appendectomy specimens useful? A systematic review of the literature

Colorectal Dis. 2011 Nov;13(11):1214-21. doi: 10.1111/j.1463-1318.2010.02457.x.


Aim: Histopathological examination of the appendix after appendectomy is routinely performed. The object of this systematic review is to determine whether routine histopathological examination of the appendix is justified.

Method: PubMed, EMBASE, Web of Science and the Cochrane library were searched without language restriction up to 1 October 2009. All articles that reported on the incidence of histopathologically proven aberrant appendiceal pathology were included.

Results: Nineteen case series reported the incidence of a benign neoplasm [0.5%, weighted mean (WM)], malignant neoplasm (0.2%, WM) and other pathology (0-14%). Nine articles reported the sensitivity of the intra-operative findings to detect aberrant diagnoses. Parasitic infection was detected in 0-19%, endometriosis in 0% and granulomatosis in 0-11% of cases. Five articles addressed the consequences of aberrant pathology. Most patients with parasite infection, granulomatosis and malignant neoplasms underwent additional investigation or treatment, in contrast to patients with a benign neoplasm.

Conclusion: The incidence of unexpected findings in appendectomy specimens is low and the intra-operative diagnosis alone appears insufficient for identifying unexpected disease. The benefit of histopathology is studied inadequately. From the present available evidence, routine histopathology cannot be judged as useless.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Appendectomy
  • Appendiceal Neoplasms / epidemiology*
  • Appendiceal Neoplasms / pathology
  • Appendix / parasitology
  • Appendix / pathology*
  • Appendix / surgery
  • Diagnostic Tests, Routine*
  • Granuloma / epidemiology
  • Granuloma / pathology
  • Humans
  • Incidence
  • Incidental Findings*
  • Parasitic Diseases / epidemiology
  • Parasitic Diseases / pathology