Correlation of Cytomorphology and i=Immunohistochemical Staining Patterns of Serous Cavity Effusion Metastases with Breast Tumor Grade: A County Hospital Experience

Abstract

Introduction: Massachusetts was an early adopter of the Accountable Care Organization payment model. In response, Healthcare systems have been under pressure to reduce costs and evaluate resource allocation to optimize patient care. In the Cytopathology laboratory, we hypothesized that changing from reflex cellblock (RCB) preparation for fluids (FL) to a selective CB (SCB) preparation method would reduce cost without compromising care. Materials and Methods: Two FL cohorts were analyzed and compared for utility and cost of specimen preparation for diagnosis. The RCB group was composed of all FL cases from 2009 when CBs were prepared for all FL specimens to supplement the SurePath slide. The SCB group was from 2011, when the workflow was modified to prepare CB only on those cases where cytological evaluation of the SurePath slide indicated a need for ancillary testing. Cost for cellblock preparation was estimated to be $20 for technical charges for preparing a CB. Results: The RCB groups consisted of 951 CB from 951 FL (100%). A negative interpretationwasmade on both SurePath andCB in 73%of cases, and a malignant diagnosis without ancillary testing was made on both in 13% of cases. Ancillary testing, contributing to final diagnosis was performed on 16% of the CB. The SCB consisted of 261 CB from 1386 FL (19%); a reduction of CBpreparations of 81%.Anegative interpretationwasmade on both SurePath and CB in 30% of cases. A malignant diagnosis that did not need ancillary testing was made on both in 30% of cases. Ancillary testing, contributing to the final diagnosis was performed on 41% of the SCB cases. An estimation of savings from the modified workflow was $22,500 not including pathologist charge and ancillary testing. Conclusions: Selectively processing CB from FL reduces laboratory costs without compromising patient care.