CLINICAL AND COST IMPACT OF 2ND-OPINION PATHOLOGY - REVIEW OF PROSTATE BIOPSIES PRIOR TO RADICAL PROSTATECTOMY

Despite numerous studies evaluating second-opinion surgical programs, we are unaware of work evaluating the cost effectiveness of a second o pinion for pathology prior to surgery. One of six pathologists reviewe d the pathology of the outside needle biopsies of 535 consecutive men referred to Johns Hopkins Hospital for radical prostatectomy over a 12 -month period (from October 1993 until October 1994) before the men un derwent surgery. Of the 535 needle biopsies initially diagnosed on the outside as adenocarcinoma of the prostate, seven (1.3%) were reclassf ied as benign upon pathology review at Johns Hopkins Hospital. The mos t common lesion misinterpreted as adenocarcinoma was adenosis or less pronounced examples of adenosis consisting of foci of crowded glands ( five cases). Foci of atrophy in the remaining two cases were misdiagno sed as adenocarcinoma of the prostate. Upon subsequent clinical work u p, six of seven men were considered not to have adenocarcinoma, and th eir surgery was cancelled. The cost for reviewing all 535 preoperative needle biopsies was $44,883, which included the cost of immunohistoch emical studies for high-molecular-weight cytokeratin and repeat biopsi es and ultrasounds in men whose diagnoses were reversed. The total cos t of the radical prostatectomies had the six men undergone surgery was estimated at $85,686, including hospitalization, anesthesia, radical prostatectomy pathology, and surgery. This cost savings did not includ e other costs resulting from lost wages, morbidity, or potential litig ation. Second-opinion pathological evaluation of prostate biopsy befor e radical prostatectomy is cost effective and has a major impact on cl inical treatment for a subset of patients.