Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy: how useful is it?

OBJECTIVE To determine the usefulness of "routine" lacrimal sac biopsy to evaluate unsuspected neoplasm or systemic disease in patients with acquired nasolacrimal duct obstruction. DESIGN Noncomparative, interventional case series with histopathologic correlation. PARTICIPANTS Review of charts revealed histopathologic reports on 302 specimens from 258 patients who had undergone routine dacryocystorhinostomy for clinical acquired nasolacrimal duct obstruction. INTERVENTION Dacryocystorhinostomy (DCR) with histopathologic evaluation of lacrimal sac. MAIN OUTCOME MEASURES The following variables were extracted from the medical records: age, gender, presenting symptoms, history of predisposing conditions, lacrimal system abnormalities noted before surgery, dye disappearance test, dacryocystogram or dacryoscintillogram, appearance of the lacrimal sac during surgery, and histopathologic report of the lacrimal sac specimen. RESULTS Findings of histopathologic evaluation of 302 lacrimal sac specimens from 170 females and 88 males who had undergone routine DCR were reviewed. Evidence of systemic disease or neoplasia involving the lacrimal sac was present in 10 specimens. All 10 positive specimens had a grossly abnormal appearing sac at the time of surgery (n = 8), a known preexisting history of systemic diseases (n = 6), or both. The remaining 292 specimens showed chronic inflammation, fibrosis, or normal mucosa. CONCLUSIONS Only patients with known preexisting systemic disease or a grossly abnormal lacrimal sac had "positive" histopathologic findings. We recommend that lacrimal sac biopsy in patients undergoing DCR should be performed only in those with a positive history for systemic disease or an abnormal-appearing lacrimal sac during surgery.