Rajasekaran Karthik, Haffey Timothy, Halderman Ashleigh, Hoschar Aaron P, Sindwani Raj
Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Otolaryngol Head Neck Surg. 2014 Sep;151(3):503-7. doi: 10.1177/0194599814534389. Epub 2014 May 8.
Inferior turbinate surgery for nasal obstruction can be performed in a variety of ways. Only a few of these methods produce tissue that can be sent for pathologic analysis. According to the College of American Pathologists, turbinate tissues are not exempt from requisite pathologic evaluation. Our objectives were to evaluate the clinical value and cost implications of routine pathological examination of turbinate specimens.
Case series with chart review.
Academic tertiary care medical center.
Charts of patients who underwent an inferior turbinate procedure for nasal obstruction between January 2008 and August 2011 were reviewed.
Thirteen hundred consecutive cases from 17 surgeons were identified. Among these patients, 223 (17%) underwent an isolated turbinate reduction procedure and 779 (59%) underwent a reduction procedure in conjunction with a septoplasty. The remaining patients had a turbinate procedure in addition to another head and neck procedure. Only 591 (45%) turbinate reduction procedures were performed by methods that were tissue producing, and of these, 137 (23%) were sent for pathologic analysis. All submitted specimens received a gross examination and 123 (90%) also underwent histologic analysis. No abnormalities were reported.
At our institution, most surgeons did not submit turbinate tissues for pathologic examination even when a specimen was produced. Of the specimens sent, no abnormal pathologic results were identified. Our results suggest that routine pathologic evaluation of inferior turbinate specimens may not contribute to patient care and perhaps represents an unnecessary cost.
针对鼻塞的下鼻甲手术有多种实施方式。其中只有少数几种方法能获取可送检进行病理分析的组织。根据美国病理学家学会的说法，鼻甲组织也需要进行必要的病理评估。我们的目的是评估鼻甲标本常规病理检查的临床价值和成本影响。
回顾图表的病例系列研究。
学术性三级医疗中心。
回顾了2008年1月至2011年8月间因鼻塞接受下鼻甲手术患者的病历。
共确定了来自17位外科医生的1300例连续病例。在这些患者中，223例（17%）接受了单纯下鼻甲缩小术，779例（59%）在鼻中隔成形术的同时接受了下鼻甲缩小术。其余患者除了接受头颈部其他手术外还接受了下鼻甲手术。只有591例（45%）下鼻甲缩小术采用了能获取组织的方法，其中137例（23%）被送去做病理分析。所有送检标本都进行了大体检查，123例（90%）还进行了组织学分析。未报告异常情况。
在我们机构，即使获取了标本，大多数外科医生也未将鼻甲组织送检进行病理检查。在送检的标本中，未发现异常病理结果。我们的结果表明，下鼻甲标本的常规病理评估可能对患者治疗没有帮助，也许是一项不必要的费用。
