Clinical and cost impact of second-opinion pathology - Review of prostate biopsies prior to radical prostatectomy
Clinical and cost impact of second-opinion pathology - Review of prostate biopsies prior to radical prostatectomy
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DOI：
10.1097/00000478-199607000-00008
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发表时间：
1996-07-01
影响因子：
5.6
通讯作者：
Sanfilippo, F
中科院分区：
文献类型：
--
作者：
Epstein, JI;Walsh, PC;Sanfilippo, F
尽管有大量研究评估第二意见手术方案，但我们不知道有哪些工作评估手术前病理学第二意见的成本效益。六名病理学家中的一位对 535 名连续转诊至约翰·霍普金斯医院进行根治性前列腺切除术的男性进行了手术前 12 个月期间（从 1993 年 10 月至 1994 年 10 月）的外部针活检的病理学检查。在 535 例最初在外部诊断为前列腺腺癌的针吸活检中，有 7 例 (1.3%) 在约翰霍普金斯医院进行病理检查后被重新分类为良性。最常见的被误认为腺癌的病变是腺病或由拥挤腺体病灶组成的不太明显的腺病实例（五例）。其余2例因萎缩灶被误诊为前列腺腺癌。经过随后的临床检查，七名男性中有六人被认为没有患腺癌，他们的手术被取消。审查所有 535 例术前穿刺活检的费用为 44,883 美元，其中包括高分子量细胞角蛋白的免疫组织化学研究费用以及诊断逆转的男性的重复活检和超声检查的费用。这六名男子接受根治性前列腺切除术的总费用估计为 85,686 美元，包括住院费、麻醉费、根治性前列腺切除术病理费和手术费。这种节省的成本不包括因工资损失、发病率或潜在诉讼而产生的其他成本。根治性前列腺切除术之前对前列腺活检进行第二意见病理学评估具有成本效益，并且对部分患者的临床治疗具有重大影响。
Despite numerous studies evaluating second-opinion surgical programs, we are unaware of work evaluating the cost effectiveness of a second opinion for pathology prior to surgery. One of six pathologists reviewed the pathology of the outside needle biopsies of 535 consecutive men referred to Johns Hopkins Hospital for radical prostatectomy over a 12-month period (from October 1993 until October 1994) before the men underwent surgery. Of the 535 needle biopsies initially diagnosed on the outside as adenocarcinoma of the prostate, seven (1.3%) were reclassfied as benign upon pathology review at Johns Hopkins Hospital. The most common lesion misinterpreted as adenocarcinoma was adenosis or less pronounced examples of adenosis consisting of foci of crowded glands (five cases). Foci of atrophy in the remaining two cases were misdiagnosed as adenocarcinoma of the prostate. Upon subsequent clinical work up, six of seven men were considered not to have adenocarcinoma, and their surgery was cancelled. The cost for reviewing all 535 preoperative needle biopsies was $44,883, which included the cost of immunohistochemical studies for high-molecular-weight cytokeratin and repeat biopsies and ultrasounds in men whose diagnoses were reversed. The total cost of the radical prostatectomies had the six men undergone surgery was estimated at $85,686, including hospitalization, anesthesia, radical prostatectomy pathology, and surgery. This cost savings did not include other costs resulting from lost wages, morbidity, or potential litigation. Second-opinion pathological evaluation of prostate biopsy before radical prostatectomy is cost effective and has a major impact on clinical treatment for a subset of patients.