Frequency of unexpected and important histopathological findings in routine intervertebral disc surgery

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p> The value of routine histopathological examination of intervertebral disc tissue has been questioned, but sufficient numbers of studies have yet to be conducted to provide a definitive sense of its importance. The aim of this study was to investigate the nature and frequency of unexpected histopathological findings in intervertebral disc surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p> The authors conducted a retrospective examination of consecutive surgical specimens obtained in patients with benign indication for discectomy at four neurosurgical centers.</jats:p> <jats:p>Surgical specimens obtained during 2102 operations (2177 intervertebral discs) in 2017 patients were evaluated. In addition to one case of cavernous malformation, two specimens (obtained in 0.1% of patients) revealed unexpected pathological diagnoses of malignancy (metastasized prostate carcinoma and diffuse large B-cell lymphoma).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p> The results of this retrospective study suggest that routine histopathological examination of specimens obtained during intervertebral disc procedures is both justified and cost effective.</jats:p></jats:sec>

Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis

“…Those diagnoses were not benign and consisted of amyloidosis with unusual immunological features, metastatic prostate carcinoma, and diffuse large B-cell lymphoma 16,17 . While the rate of discordant diagnoses found within the intervertebral disc space during routine surgical intervention approximated that seen with total hip and knee arthroplasty and shoulder and knee arthroscopy, more malignant diagnoses were observed.…”

“…Previous studies have demonstrated extremely low diagnostic value and high costs of histological examinations following a variety of procedures, including thumb, knee, and hip arthroplasty; lumbar and cervical discectomy; hallux valgus surgery; wrist ganglion excision; and shoulder and knee arthroscopy [6][7][8][9][10][11][12][13][14][15][16][17][18][19][23][24][25][26][27][28] (see Appendix). While these represent various procedures under different settings, different clinical and histological diagnoses occurred in 0% to 9% of the cases.…”

“…The spine literature regarding histological evaluation of routine intervertebral disc surgery has demonstrated substantial costs and a small percentage of discordant diagnoses (0.048%; three of 6235 cases) [11][12][13][14][15][16][17] . Those diagnoses were not benign and consisted of amyloidosis with unusual immunological features, metastatic prostate carcinoma, and diffuse large B-cell lymphoma 16,17 .…”

“…The cost per discordant diagnosis in a variety of procedures has typically been reported to be >$120,000 per case [6][7][8][9][10][11][12][13][14][15][16][17][18][19] .…”

“…The definitions proposed by Raab et al 6 of concordant agreement between clinical and pathological diagnoses, discrepant diagnosis without a change in patient management, and discordant diagnosis resulting in altered patient management were utilized in our study. Similar studies have used these definitions as well, allowing an in-depth analysis of the literature [6][7][8][9][10][11][12][13][14][15][16][17][18][19] . In order to determine the cost of the histological examinations, the Medicare fee schedule for 2012 was used for both technical and professional portions of billing utilizing CPT codes 88304 (surgical pathology gross and microscopic, non-fracture) and 88313 (decalcification).…”