Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States of America.
MHealth Fairview Laboratories, Minneapolis, MN, United States of America.
Ann Diagn Pathol. 2023 Dec;67:152214. doi: 10.1016/j.anndiagpath.2023.152214. Epub 2023 Sep 28.
There are immunohistochemistry (IHC) and immunofluorescence (IF) panels described in the literature and established by personal and institutional experiences that are in common use by pathologists in their daily practice. Stewardship is a difficult discussion because IHC utilization is influenced by many factors including the pathologist's experience, background, practice setting, personal bias, and medicolegal culture. We developed the methodology to audit the IHC/IF utilization in our academic subspecialty practice. We aim to share this methodology and to provide our data that can be used for consideration by other subspecialized academic practices. This analysis included a total of 63,157 specimens that were accessioned during 2022, representing 38,612 cases. The likelihood of ordering IHC/IF ranged from 1 % (in genitourinary pathology) to 59 % (in renal pathology). The average percentage of specimens with IHC/IF was 21 % for the entire practice. In cases where IHC/IF was ordered, the number of stained slides averaged 4.9 per specimen for the entire practice. The number of IHC/IF slides per specimen ranged from 1.9 (in gastrointestinal pathology) to 12.2 (in renal pathology). The highest number of antibodies ordered for a single specimen by subspecialty ranged from 11 (in cardiac pathology) to 63 (in dermatopathology). Renal pathology was the only subspecialty that had an average number of IHC/IF slides that was statistically significantly different from all other subspecialties. We described the various patterns of utilization by subspecialty and rationalized their subtle differences. We also analyzed the types of cases that exceeded the reimbursement limits set by the Centers for Medicare and Medicaid Services (CMS).
有一些免疫组织化学（IHC）和免疫荧光（IF）检测面板在文献中有描述，并通过个人和机构经验得到确立，这些面板在病理学家的日常实践中得到广泛应用。管理是一个困难的讨论，因为 IHC 的使用受到许多因素的影响，包括病理学家的经验、背景、实践环境、个人偏见和法医学文化。我们开发了一种方法来审核我们学术亚专科实践中的 IHC/IF 使用情况。我们旨在分享这种方法，并提供我们的数据，以供其他专业学术实践考虑。该分析共包括 2022 年收录的 63157 份标本，代表 38612 例病例。IHC/IF 检测的可能性范围从 1%（泌尿生殖系统病理学）到 59%（肾脏病理学）。整个实践中，IHC/IF 检测的标本平均百分比为 21%。在 IHC/IF 检测被要求的病例中，整个实践中平均每个标本的染色切片数为 4.9 张。每个标本的 IHC/IF 切片数范围从 1.9 张（胃肠病理学）到 12.2 张（肾脏病理学）。按亚专科分类，单个标本订购的抗体数量最多的从 11 个（心脏病理学）到 63 个（皮肤病理学）不等。肾脏病理学是唯一平均 IHC/IF 切片数量与所有其他亚专科有统计学差异的亚专科。我们描述了按亚专科分类的各种使用模式，并对其细微差异进行了合理化解释。我们还分析了超出医疗保险和医疗补助服务中心（CMS）设定的报销限制的病例类型。
