Division of Plastic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
From the Department of Plastic and Reconstructive Surgery, Ochsner Clinic Foundation.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 4):S416-S419. doi: 10.1097/SAP.0000000000003455. Epub 2023 Mar 15.
Routine pathology examination of breast tissue in reduction mammaplasty (RM) is performed with aims of detecting incidental malignancy or risk-increasing lesions. In adolescent patients, the reported incidence ranges between 0% to 0.01%, and costs of pathology claims range between $23 and $614 per analysis. We aim to investigate the rate of incidental findings and the cost-effectiveness of routine pathology examination in adolescent RM.
A single-center retrospective review of the pathology results for 132 breast specimens from 66 consecutive RM patients was performed. Data collected for analysis included breast cancer risk factors, demographic information, and operative variables.
Zero cases of incidental malignant or risk-increasing lesions were found among the 132 breast specimens from 66 patients aged between 10 and 24 years. Of the 132 specimens, 34 (26%) contained benign fibrocystic disease, which was significantly associated a body mass index greater than 30 kg/m 2 and tissue resection weight greater than 1000 g per breast ( P = 0.003, P = 0.007) respectively.
Based on the available data, the use of routine specimen analysis costs more than US $150 million for one breast cancer diagnosis during RM in this age group. In our study, zero atypical, precancerous, or cancerous lesions were detected in a 7-year analysis. The results of this study support the current literature, which reports no occurrence of incidental findings in young women and may promote a greater understanding of evidence-based healthcare spending while concomitantly decreasing the strain placed on histopathology services.
在缩乳术（RM）中，常规对乳房组织进行病理学检查，目的是检测偶然发现的恶性肿瘤或增加风险的病变。在青少年患者中，报告的发病率在 0%至 0.01%之间，每次分析的病理学索赔费用在 23 美元至 614 美元之间。我们旨在研究青少年 RM 中偶然发现的发生率和常规病理学检查的成本效益。
对 66 例连续 RM 患者的 132 例乳房标本的病理学结果进行了单中心回顾性研究。为分析而收集的数据包括乳腺癌风险因素、人口统计学信息和手术变量。
在 66 名 10 至 24 岁患者的 132 个乳房标本中，未发现偶然发现的恶性或增加风险的病变。在 132 个标本中，34 个（26%）含有良性纤维囊性疾病，这与 BMI 大于 30kg/m2 和每个乳房的组织切除重量大于 1000g 显著相关（P=0.003，P=0.007）。
根据现有数据，在该年龄段的 RM 中，常规标本分析的使用费用超过 1.5 亿美元，才能诊断出一例乳腺癌。在我们的研究中，在 7 年的分析中未发现任何非典型、癌前或癌症病变。本研究的结果支持了目前的文献报告，即年轻女性中偶然发现的病变发生率为零，这可能有助于更好地了解循证医疗支出，同时减轻组织病理学服务的负担。
