HISTOPATHOLOGIC REVIEW OF PROSTATE BIOPSIES FROM PATIENTS REFERRED TOA COMPREHENSIVE CANCER CENTER - CORRELATION OF PATHOLOGICAL FINDINGS,ANALYSIS OF COST, AND IMPACT ON TREATMENT
Jc. Wurzer et al., HISTOPATHOLOGIC REVIEW OF PROSTATE BIOPSIES FROM PATIENTS REFERRED TOA COMPREHENSIVE CANCER CENTER - CORRELATION OF PATHOLOGICAL FINDINGS,ANALYSIS OF COST, AND IMPACT ON TREATMENT, Cancer, 83(4), 1998, pp. 753-759
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.