Diagnostic discrepancy among clinical, surgical, and histopathological stages in cholecystectomies: A multivariate analysis of associated factors

Flores-Palacios R.; Quispe-Mamani L.; Encinas-Llica R.; Huaycani-Aduviri J.; Ramos-Vilca A.; Mamani-Cruz R. · Revista Colombiana de Cirugia (2026) · DOI: 10.30944/20117582.3167

Resumen

Introduction. The concordance among the clinical, surgical, and histopathological diagnoses of cholecystitis is limited and variable, which generates diagnostic uncertainty and affects therapeutic decision-making. Methods. A retrospective cohort study of patients with available clinical, intraoperative, and histopathological diagnoses was conducted. Each diagnostic stage was classified as acute and chronic cholecystitis, or other diagnoses. Factors associated with clinical-surgical and surgical-histopathological discordance were identified using Poisson regression with robust variance, estimating adjusted prevalence ratios (aPR). Results. A total of 492 patients were included. Histopathological diagnosis identified chronic cholecystitis in 78.0% of cases and acute cholecystitis in 18.9%. Clinical-surgical discordance was low (3.9%), whereas surgicalhistopathological discordance reached 30.1%. In the adjusted model, elevated alkaline phosphatase (≥240 U/L) increased the prevalence of clinical-surgical discordance (aPR: 3.93; 95%CI: 1.33-11.60), while leukocytosis (>11,000 cells/µL) reduced it (aPR: 0.03; 95%CI: 0.01-0.06). Right hypochondrial pain (aPR: 3.72; 95%CI: 2.49-5.55) and elevated alkaline phosphatase (aPR: 1.40; 95%CI: 1.08-1.82) increased surgical-histopathological discordance, whereas the presence of multiple gallstones (aPR: 0.76; 95%CI: 0.60-0.97) and leukocytosis (aPR: 0.63; 95%CI: 0.45-0.88) decreased it. Conclusions. Diagnostic discordance increases progressively from clinical to histopathological evaluation, demonstrating a preoperative overestimation of acute cholecystitis. Elevated alkaline phosphatase constitutes the primary factor associated with discordance in both comparisons. These findings highlight the complexity of the diagnostic process and underscore the need to optimize clinical, laboratory, and ultrasound criteria to enhance diagnostic accuracy and strengthen surgical practice.

Instituciones: Universidad Nacional Jorge Basadre Grohmann