Safir Ilan J, Patel Amar P, Moore Brad P, Patil Dattatraya, Bellott-McGrath Gabriel, Osunkoya Adeboye O, Issa Muta M
Department of Urology, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.
Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
Urol Pract. 2015 Jul;2(4):149-153. doi: 10.1016/j.urpr.2014.11.003. Epub 2015 Apr 10.
We determined the clinical impact and value of routine histopathological examination of the foreskin following circumcision.
We performed a retrospective study of 225 consecutive adult circumcisions. Indications for circumcision were categorized as benign or malignant based on preoperative clinical evaluation. Histopathological results were similarly classified as benign or malignant. Preoperative clinical impression and postoperative histological diagnosis were compared and reported as concordant (in agreement) or discordant (in disagreement). The cost impact of histopathology examination was analyzed with respect to study findings.
Of the 225 patients 209 (92.9%) had clinically benign disease on preoperative evaluation and 16 (7.1%) had foreskin lesions suspicious for malignancy. Mean age was 57.0 years (range 23 to 92). Patients were younger in the benign group than in the malignant group (56.5 vs 62.8 years, p = 0.018). Black patients represented 65.8% of the study population and were similarly distributed between the 2 groups (p = 0.405). There was no statistical difference in patient height, weight, body mass index or comorbidities between the 2 groups. Preoperative clinical impression and postoperative histological diagnosis were concordant in all 209 patients in the benign group. Of the 16 patients suspected to have malignant disease preoperatively 9 (56.2%) had malignancy and 7 (43.8%) had benign disease on histopathological examination.
Routine histological examination of a foreskin specimen in the absence of clinical suspicion for malignancy appears to have diminished benefit in the setting of benign preoperative indications. Omitting this traditional practice in patients with benign surgical indications may positively impact health care costs without compromising quality of care.
我们确定了包皮环切术后包皮常规组织病理学检查的临床影响和价值。
我们对连续225例成年包皮环切术进行了回顾性研究。根据术前临床评估，将包皮环切术的指征分为良性或恶性。组织病理学结果也同样分为良性或恶性。比较术前临床印象和术后组织学诊断，并报告为一致（相符）或不一致（不符）。根据研究结果分析了组织病理学检查的成本影响。
在225例患者中，209例（92.9%）术前评估为临床良性疾病，16例（7.1%）有可疑恶性的包皮病变。平均年龄为57.0岁（范围23至92岁）。良性组患者比恶性组患者年轻（56.5岁对62.8岁，p = 0.018）。黑人患者占研究人群的65.8%，在两组中分布相似（p = 0.405）。两组患者的身高、体重、体重指数或合并症无统计学差异。良性组的20个9例患者术前临床印象和术后组织学诊断一致。在术前怀疑患有恶性疾病的16例患者中，9例（56.2%）组织病理学检查为恶性，7例（43.8%）为良性疾病。
在术前无恶性临床怀疑的情况下，对包皮标本进行常规组织学检查在良性术前指征的情况下似乎益处不大。对于有良性手术指征的患者省略这种传统做法可能会对医疗成本产生积极影响，而不会影响医疗质量。
