© 2003 BMJ Publishing Group Ltd. & Association of Clinical Pathologists
VIEWPOINT
Pathology and operative strategy
Pathology and operative strategy
Correspondence to:
Correspondence to:
Mr A Reddi, Department of Cardiothoracic Surgery, Wentworth Hospital, Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa;
welman@nu.ac.za
What if a preoperative diagnosis is unavailable?
Keywords: pathology; operative strategy; preoperative diagnosis
| The first 150 words of the full text of this article appear below. |
As a general principle, in elective surgery, it is considered advisable to establish a pathological diagnosis (by cytology or histology, and occasionally by microbiological means) before the removal of a lesion, with or without the associated organ or part thereof. The rationale for this approach is obvious: to rule out the possibility of an alternative form of treatment—that is, a more conservative one—that will obviate the need for surgical resection. Take—for example, endobronchial tuberculosis, which may on clinical, radiographical, and endoscopical grounds be indistinguishable from bronchial carcinoma. In this instance, to remove a lung or lobe without histological confirmation would clearly be catastrophic. However, it is not always possible to obtain tissue for preoperative diagnosis. Inaccessible organs/lesions or the invasive nature of the diagnostic manoeuvre may make the procedure hazardous, with a statistically significant morbidity and, occasionally, even mortality. Under these circumstances, the clinician may have
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