Pornkul Panuwat, Lampe Guy, Bertucci Renae, Wickramasinghe Shehan, Klein Kerenaftali, Mushaya Chrispen, Sakata Shinichiro
Division of Colorectal Surgery, Department of Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Colorectal Dis. 2025 Mar;27(3):e70056. doi: 10.1111/codi.70056.
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.
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.
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).
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.
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，因为其效用存在争议。这是第一项评估低风险和高风险患者中肛门鳞状上皮内病变（aSIL）和肛门鳞状细胞癌（aSCC）检出率的研究。
这项为期9年的回顾性研究评估了澳大利亚一家三级转诊医院内所有接受痔切除术患者的电子病历。临床检查结果可疑的患者被排除在研究之外。收集的数据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。还进行了常规病理送检的成本效益分析以及一项全市范围的外科医生调查，以确定当前的做法。
偶然发现的aSIL和aSCC的总体患病率为27例（8.1%）；19例患者（5.7%）有低级别鳞状上皮内病变（LSIL），7例（2.1%）有高级别鳞状上皮内病变（HSIL），1例患者（0.3%）有aSCC。四分之三以上在低风险患者中被检测到，大多数病例为LSIL。比较低风险和高风险患者，观察到的aSIL和aSCC偶然检出率分别为6.8%（95%可信区间4.49 - 10.17）和23.1%（95%可信区间11.03 - 52.05）。多因素逻辑回归显示，高风险因素与检测到aSIL和aSCC之间存在显著的强关联（比值比3.76，95%可信区间1.32 - 10.68，P = 0.013）。一项全市范围的外科医生调查显示，28.6%的医生不要求进行常规组织病理学评估，64.3%的医生认为痔中可疑偶然病理的患病率为1%或更低。每位患者进行常规组织病理学评估的总成本为96.80澳元（59.20欧元，65.30美元）。
鉴于低风险和高风险患者中aSIL和aSCC的偶然检出率不可忽视，再加上组织病理学检查的成本效益，本研究表明常规组织病理学检查不应仅局限于高风险患者。需要进一步研究低风险和高风险患者临床检测后进行监测的益处。
