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$Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus$

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The Role of Routine Pathologic Assessment After Pediatric Osteochondroma Excision.

Lindley B Wall^1,2, David Clever¹, Lauren E Wessel³

¹Department of Orthopaedic Surgery, Washington University School of Medicine.

Journal of Pediatric Orthopedics

|June 25, 2024

Summary

Routine pathologic analysis of pediatric osteochondromas is often unnecessary, saving costs without altering diagnosis or management. Consider "gross only" analysis for typical cases, reserving full histologic evaluation for ambiguous or concerning presentations.

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Area of Science:

Orthopaedic Surgery
Pediatric Oncology
Surgical Pathology

Background:

Osteochondromas are common benign bone tumors frequently requiring surgical excision.
Post-excision pathologic analysis is standard but may not always be clinically or economically valuable.
This study evaluates the utility of routine pathology in pediatric osteochondroma resections.

Purpose of the Study:

To determine the clinical and economic value of routine postoperative pathologic analysis of osteochondromas in pediatric patients.
To assess whether routine histologic examination of excised osteochondromas impacts diagnosis or patient management.
To evaluate the cost-effectiveness of current pathologic analysis protocols for pediatric osteochondromas.

Main Methods:

Retrospective review of clinical records from 2 pediatric orthopaedic hospitals.
Analysis of 426 osteochondroma resections from 201 pediatric patients (ages 2.1-17.9 years).
Inclusion of solitary and multiple osteochondroma lesions; data on clinical, radiographic, surgical, and pathologic findings, including costs.

Main Results:

All 426 resected osteochondromas were histologically confirmed as benign.
No cases required altered diagnosis or management based on routine pathologic analysis.
Routine pathologic analysis incurred costs of approximately $755 per lesion, totaling $321,630 for the cohort.

Conclusions:

Routine postoperative histologic analysis is not strictly indicated for most pediatric osteochondroma excisions.
A "gross only" analysis may suffice for typical cases, reducing costs.
Full histologic evaluation remains prudent for cases with preoperative diagnostic ambiguity or concerning features.