Utility of Additional Tissue Sections in Surgical Pathology

Area of Science:

• Pathology
• Surgical Pathology
• Diagnostic Accuracy

Background:

• Pathologists utilize additional sections (AS) to mitigate diagnostic errors like missed diagnoses or incorrect tumor staging.
• Inadequate tissue sampling poses a significant risk in pathological evaluations.

Purpose of the Study:

• To evaluate the frequency, diagnostic yield, distribution, and associated costs of additional sections (AS).

Main Methods:

• Analysis of 1542 cases to determine mean AS per case.
• Calculated the proportion of AS that altered diagnosis or staging.
• Examined AS variation based on tissue type, lesion type (malignant vs. benign), neoadjuvant therapy, specimen site (mass, margin, lymph nodes), and dissector (resident vs. pathologist assistant).
• Assessed the cost per case for AS.

Main Results:

• An average of 9.2 ± 8.8 AS were used per case, with only 3.8% altering the diagnosis or stage.
• Urinary bladder specimens required the most AS (19.5 ± 15.1 per case).
• Malignant lesions and those treated with neoadjuvant therapy yielded significantly more AS.
• Lymph nodes were heavily sampled, but most AS originated from the tumor mass.
• AS accounted for 40% of the total cost per case.

Conclusions:

• The use of additional sections (AS) varies widely, with a low diagnostic yield and high cost.
• AS are most frequent in urinary bladder, malignant, and neoadjuvant-treated lesions.
• While lymph nodes are frequently sampled, masses are the primary source of AS; resident dissection did not significantly impact AS quantity.