Positive economic and diagnostic accuracy impacts of on-site evaluation of fine needle aspiration biopsies by pathologists

Acta Cytol. 1996 Nov-Dec;40(6):1227-30. doi: 10.1159/000333985.

Abstract

Objective: To investigate the impact of pathologists' immediate evaluation of fine needle aspiration biopsy (FNAB) on increasing diagnostic yield and decreasing related expenses.

Study design: All FNABs performed at our 420-bed hospital between January 1992 and December 1994 were reviewed. The 1992-1993 FNABs were all performed without pathologist attendance. Smears were wet fixed in 95% alcohol and later stained by the Papanicolaou or hematoxylin and eosin methods. The remaining aspirated material was collected in Saccomano's preservative, and a cell block was made. Nearly all the 1994 FNABs were performed with the pathologist present; he examined air-dried, Diff-Quik-stained smears for preliminary evaluation of the aspirate. An average of three passes were done. The rest of the procedure was as usual.

Results: The total number of 1992-1993 FNABs was 227 (108 + 119); of them, 104 (46%) were inadequate for diagnosis. In contrast, the 1994 FNABs totaled 169, with only 40 (24%) inadequate for diagnosis. The vast majority of the aspirates were done on deep-seated lesions under computed tomography (CT) guidance.

Conclusion: The results of our experience indicate that on-site evaluation by a pathologist greatly increases the diagnostic yield. Another advantage is the significant financial savings as compared to excisional tissue biopsy. In general, the expenses of a CT-guided FNAB (e.g., pancreas) average around $1,400, while charges for excisional biopsy under general anesthesia with a subsequent two- to three-day hospitalization average about $7,720.

MeSH terms

  • Biopsy / economics
  • Biopsy, Needle / economics
  • Biopsy, Needle / methods*
  • Humans
  • Medical Staff, Hospital*
  • Pathology, Surgical / economics
  • Tomography, X-Ray Computed / economics