Abstract
Objectives: Academic institutions routinely require in-house review of pathology prior to treatment. However, it is unclear if pathology review is beneficial for the management of patients referred for cervical intraepithelial neoplasia (CIN). This study aims to determine if review of outside pathology for CIN at an academic medical center resulted in a change in the treatment plan and the associated cost for pathology review. Methods: A retrospective chart review of patients referred for treatment of CIN, including review of outside cytology and histology was performed from January 1 to December 31, 2007 after obtaining IRB approval. Data was analyzed to determine whether pathology diagnosis was changed from the outside facility interpretation; classified as minor if there was no change in clinical management and major if there was a change in treatment as a result of the internal review. Demographic and pathology information was collected from electronic medical records. Billing information was collected from the finance department. Data were analyzed using descriptive statistics. Results: Seventy-eight patients were identified of which 54 had outside pathology slides available for pathology review. Eleven had a minor change in the pathology diagnosis (20%). None of the changes in pathology diagnosis resulted in a change in treatment plan (major). The total pathology review charge was $14,679 for the 54 patients, with an average charge per patient of $272. Nine of the cases were charged twice to reflect the opinion of two separate pathologists (internal consultation). Of the 54 patients, 23 (43%) had state supported insurance, 24 (44%) had private insurance, and 7 (13%) were self-pay. A total of $12,969.29 was not covered/paid (88% of all charges) and thus absorbed by the institution. Conclusion: Mandatory review of outside pathology is a common practice. However, it may not be beneficial in all clinical situations. While this pathology review for CIN resulted in minor changes for 20% of patients referred to our academic/tertiary institution, it did not affect any treatment recommendations. Pathology review did increase the cost burden to the institution and the patient.
Highlights
It is estimated that over 300,000 women in the United States have a diagnosis of cervical intraepithelial neoplasia (CIN) IIIII, the precursor to cervical cancer.[1]
A total of 78 patients were referred for treatment of CIN II-III from outside our institution, of which 54 had complete information available for analysis
None of the pathology reviews resulted in a change in treatment plan. – the recommendation for treatment was based on treatment of high grade lesions and the pathology reviews did not change from high grade to low grade or vice-versa
Summary
It is estimated that over 300,000 women in the United States have a diagnosis of cervical intraepithelial neoplasia (CIN) IIIII, the precursor to cervical cancer.[1] The annual incidence of CIN II-III is estimated at 1.5 per 1000 women annually.[2,3] Overall, the risk of progression of CIN II lesions to cancer is around 5% and the risk of progression to CIN III is 20%.4. A diagnosis of CIN III carries a 12% risk of progression to cancer. Another factor to consider is the cost of treatment. The costs per episode of care were higher for CIN II-III than CIN I ($1,634 vs $1,084) with an estimated annual burden per 1,000 US women of $1,803 for CIN II-III.[2]
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