Diagnosis Of Benign Scrotal Surgical Specimens

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Abstract Purpose: We recently demonstrated that pathologic analysis of benign scrotal surgical specimens may be unnecessarily increasing costs of patient care. Adult circumcision specimens may also routinely be sent for pathological analysis even when penile cancer is not suspected, increasing costs with little benefit. To assess the utility of foreskin pathology analysis, we evaluated the outcomes and the costs of this practice in patients where penile cancer was not suspected. Materials and Methods: All adult patients who underwent circumcision between January 2000 and August 2013 at a single institution were evaluated by retrospective chart review. Cases of suspected penile cancer (n=6) were excluded. We identified cases where foreskin specimens were sent for pathological analysis and reviewed pathology reports. Our Department of Pathology estimated the cost for evaluation of specimens at $311 per case. Results: A total of 147 circumcisions were performed in patients with no suspicious findings. Pathologic analysis was obtained in 69% (101/147) of the cases. Inflammation (58%) was the most common finding. One unsuspected instance of squamous cell carcinoma (Tis) was identified in a patient with HIV (1/147=0.7%). The overall cost of pathology analysis in this study was $31,411. Conclusions: In individuals without predisposing immunodeficiency and where cancer was not suspected, we found that pathology analysis of circumcision specimens identified no additional

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