Histologic Exams After Shoulder Procedure Not Useful

Mandatory examination didn't alter patient care

MONDAY, Feb. 11 (HealthDay News) -- Histologic examination of specimens after shoulder arthroscopy is not generally helpful and should be left to the discretion of the orthopedic surgeon rather than being mandatory, according to research published in the February issue of the Journal of Bone & Joint Surgery.

Richard E. McClain, of Goshen Orthopedic Associates LLC in Goshen, Ind., and colleagues reviewed pathology reports from specimens taken during 2,144 arthroscopic shoulder procedures performed between 1989 and 2005. The most common intraoperative diagnoses were rotator cuff tears and impingement. At some hospitals, histological examination isn't required for specimens from such procedures.

The investigators found that in all cases, the histological diagnosis agreed with the intraoperative diagnosis and never altered patient care, and no neoplasia was noted in any pathology report. The total cost for histological examinations for the procedures was an estimated $160,543.

"Our study shows that histologic examination in 2,144 shoulder arthroscopies is not cost effective. We agree with Boutin and Hogshead who recommended that the surgeon should judge in which patients a histologic examination of the surgical specimen may be productive. Histologic examination following arthroscopic shoulder surgery could occasionally be helpful, such as in patients with synovial disease or intra-articular tumors or when the arthroscopic appearance is atypical. We conclude that the regulations and guidelines of hospitals and other institutions should be revised to exclude specimens removed during shoulder arthroscopy from mandatory histologic examination," the authors write.

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