From the Department of Pathology, University of Manitoba, Winnipeg, Man. (Cormier, Fischer); the Royal London Hospital (Barts Health NHS Trust), London, U.K. (Shahid); and George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Man. (Bohm).
Can J Surg. 2020 Nov-Dec;63(6):E537-E541. doi: 10.1503/cjs.022019.
Many practices require tissues from hip and knee arthroplasty procedures to be sent for pathologic examination. These examinations rarely provide information beyond the clinical or radiologic diagnosis and rarely alter clinical management. We aimed to determine the rate at which histologic diagnoses based on gross assessment alone or gross plus microscopic assessment correspond with reported clinical diagnoses in patients undergoing total joint arthroplasties and whether the histologic diagnoses alter patient management.
We retrospectively reviewed arthroplasty cases performed at a high-volume teaching hospital in Manitoba, Canada. The clinical diagnosis was compared with the final pathology report based on gross examination, with or without histologic assessment. The results of the comparison were classified into 3 categories: concordant (same diagnosis), discrepant (different diagnoses without alterations in management) and discordant (different diagnoses resulting in management change). The overall provincial cost for pathologic examination was determined by multiplying the total examination cost by the estimated number of arthroplasty cases.
There were 773 patients in our study sample. The concordant rate was 98.3% (95% confidence interval [CI] 97.1%-99.1%), the discrepant rate was 1.7% (95% CI 0.9%-2.9%) and the discordant rate was 0.0% (95% CI 0%-0.5%) for 773 cases. The pathology diagnosis did not alter patient management in any case. A total of 91.5% of specimens did not require full histologic review and received gross descriptions only. The discrepancy rate was higher in cases that included microscopic examination than in those that received only gross descriptions (15.2% v. 0.4%, < 0.001). The overall provincial cost for pathologic examination was estimated at Can$304 556.
Submitting routine tissue from arthroplasty procedures to pathology does not affect patient management and therefore provides no value for the health care resources expended in doing so.
许多临床实践都要求对髋关节和膝关节置换术的组织进行病理检查。这些检查很少能提供超出临床或放射学诊断的信息，也很少改变临床管理。我们旨在确定基于大体评估或大体加显微镜评估的组织学诊断与接受全关节置换术的患者的报告临床诊断相吻合的比例，以及组织学诊断是否改变患者的管理。
我们回顾性地审查了在加拿大马尼托巴省一家高容量教学医院进行的关节置换病例。将临床诊断与基于大体检查的最终病理报告进行比较，无论是否进行组织学评估。比较结果分为 3 类：一致（相同诊断）、不一致（无管理改变的不同诊断）和不相符（导致管理改变的不同诊断）。通过将总检查费用乘以估计的关节置换病例数来确定全省病理检查的总费用。
我们的研究样本中有 773 名患者。773 例中，一致率为 98.3%（95%置信区间 97.1%-99.1%），不一致率为 1.7%（95%置信区间 0.9%-2.9%），不相符率为 0.0%（95%置信区间 0%-0.5%）。病理诊断在任何情况下都没有改变患者的管理。共有 91.5%的标本不需要进行完整的组织学检查，只需进行大体描述。在包括显微镜检查的病例中，不一致率高于仅接受大体描述的病例（15.2%比 0.4%，<0.001）。全省病理检查的总费用估计为 304556 加元。
提交关节置换术的常规组织进行病理检查不会影响患者的管理，因此，从卫生保健资源的角度来看，这样做没有任何价值。
