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Pathology slide review in gynecologic oncology: routine or selective?
Y M Chan1, A N Cheung, D K Cheng
1University of Hong Kong, Queen Mary Hospital, Hong Kong.
Insights
Interinstitution pathology consultation (IPC) can be optimized by excluding certain specimens. Cervical and vaginal smears, and cervical biopsy specimens from patients with gross tumors, do not require review, reducing costs by 25% without impacting patient care.
Area of Science:
- Pathology
- Gynecologic Oncology
- Health Economics
Background:
- Interinstitution pathology consultation (IPC) is a critical component of gynecologic oncology care.
- Assessing the cost-effectiveness of IPC is essential for resource optimization.
Purpose of the Study:
- To evaluate the cost-benefit ratio of IPC in gynecologic oncology.
- To identify specific specimen types with minimal risk of diagnostic error to reduce consultation costs.
Main Methods:
- A retrospective review of 569 gynecologic oncology referrals with IPC from 1993-1998.
- Comparison of original and consulted pathology reports to identify major (treatment-altering) and minor discrepancies.
- Analysis of consultation errors against final diagnoses and clinical data.
- Statistical analysis using Fisher's exact test and Pearson's correlation test.
Main Results:
- The overall major discrepancy rate was 6.5% and minor discrepancy rate was 12.5%.
- Cytological specimens had no major discrepancies, while histological specimens had a significant rate of major discrepancies (P = 0.003).
- Excluding cervical/vaginal smears and cervical biopsy specimens in cases with gross tumors could reduce costs by 25% without compromising clinical management.
Conclusions:
- Cervical and vaginal smears are suitable for exclusion from routine IPC.
- Cervical biopsy specimens from patients with clinically apparent gross tumors can also be excluded from IPC.
- Selective exclusion of low-risk specimens can significantly reduce healthcare costs associated with pathology consultations.
Objective:
The aims of this study were to assess the cost/benefit ratio for interinstitution pathology consultation (IPC) and to identify the types of specimens with little or no risk of diagnostic error in order to reduce the cost.
Methods:
All gynecologic oncology referrals having IPC from 1993 to 1998 were reviewed. Each case was evaluated by comparing both the original and the consulted pathology reports. A discrepancy was major if it led to treatment alteration. A minor discrepancy was defined as differences without clinical consequences. Consultation error was determined by comparison with the final diagnosis and clinical data obtained from the records. The cost per review was adjusted to 1998 dollars for all cases over the 5-year study period. Statistical data were obtained by Fisher's exact test and Pearson's correlation test.
Results:
Five hundred sixty-nine pathology specimens from 498 patients were analyzed in this study. The major discrepancy rate was 6.5% and the minor discrepancy rate was 12.5%. Cytological specimens accounted for no major discrepancy and 13 minor discrepancies compared to 37 major and 58 minor discrepancies in histological specimens. The difference was statistically significant (P = 0.003). Consultation errors occurred in 5 cases with no alteration of clinical care. By excluding cervical and vaginal smears and cervical biopsy specimens in cases with clinically gross tumors, the cost can be reduced by 25% with no detriment to the clinical management.
Conclusions:
The types of specimens that do not need consultative pathology review include (1) cervical biopsy specimens in those patients with gross tumors and (2) cervical and vaginal smears.