HISTOPATHOLOGIC REVIEW OF PROSTATE BIOPSIES FROM PATIENTS REFERRED TOA COMPREHENSIVE CANCER CENTER - CORRELATION OF PATHOLOGICAL FINDINGS,ANALYSIS OF COST, AND IMPACT ON TREATMENT

BACKGROUND. Clinicians at the Fox Chase Cancer Center (FCCC) base pros tate carcinoma treatment decisions regarding need to treat, field size , total dose, and adjuvant hormonal therapy on known prognostic factor s including clinical stage, Gleason score (GS), perineural invasion (P NI), and pretreatment prostate specific antigen levels. The pathology of every patient is reviewed at FCCC to confirm a diagnosis of maligna ncy. The objective of this study was to define differences between pat hologic reviews and their impact on treatment between outside institut ions and FCCC. METHODS. The authors reviewed 538 pathology reports of prostate biopsies performed at both outside pathology departments and FCCC on patients evaluated between January 1993 and December 1996. The outside pathology reviews represented 107 community hospitals, academ ic institutions, and private pathology laboratories. Patients who had received hormonal therapy, cryosurgery, or radical prostatectomy prior To prostate biopsy were excluded from analysis. Final FCCC pathology determinations were compared with pathology reports from outside insti tutions. Reports then were analyzed to determine whether differences i n interpretation would have resulted in different treatment strategies . Differences in percentages according to institutional type were eval uated using the chi-square statistic. The cost was assessed and cost p er change in treatment estimated.RESULTS. The 538 pathology reviews id entified a nearly 40% change in GS and a 13% change in greater than or equal to 2 GS between the FCCC pathology review and 107 outside acade mic institutions. The results of this study showed that 22% of communi ty hospitals, 10% of private laboratories, and 8% of academic institut ions demonstrated at least 2 GS changes compared with the FCCC patholo gy review (p = 0.001). There was no significant difference observed be tween types of institutions in the incidence of PNI. CONCLUSIONS. This analysis provides evidence of a significant difference in the patholo gic reviews of prostate biopsies conducted at FCCC and outside patholo gy departments. There was a nearly 40% change in GS and a 13% change i n greater than or equal to 2 GS between the FCCC pathology review and 107 outside institutions. The second pathology review added approximat ely $104 per case for a total of $55,952 to review all 538 cases. Over all, the savings in health care dollars resulting from the second path ologic review totaled $12,997. This second review of outside pathology in prostate cancer appears to be justified based on the treatment cha nges and on cost. Cancer 1998;83:753-9. (C) 1998 American Cancer Socie ty.