These authors conducted a retrospective review of 714 primary shoulder arthroplasty cases in which the resected humeral head was sent for routine pathologic examination.
Diagnoses were considered concordant if there was agreement between the preoperative clinical diagnosis and the pathologic diagnosis, discrepant if there was a disagreement but no change in clinical management, and discordant if there was a disagreement that required a change in clinical management of patients.
The distribution of diagnoses is shown here
The prevalence of concordant diagnoses was 94.1%, the prevalence of discrepant diagnoses was 5.9%, and no cases had discordant diagnoses. There were 172 cases that had biceps tendon specimens sent for pathology examination, and none led to a change in patient care.
Costs of routine pathologic examination were decalcification $18.78
pathologic examination of specimens $64.99/humeral head
humeral head plus biceps tendon $101.73
Comment: The authors state that "Specimens from shoulder arthroplasty cases are routinely sent for pathologic examination." This has not been the case for our practice. We obtain pathological examination of the humeral head only in the very rare case of suspected malignancy. It is more common for us to send soft tissue to evaluate the type of synovitis.
No need to spend money in gathering information that does not change treatment.
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