The Clinical Value of Histologic Examination in Shoulder Arthroscopy

Background The clinical value of histologic examination of tissues removed during shoulder arthroscopy has not been determined. The guidelines of the College of American Pathologists require routine histologic examination of all surgical specimens not specifically exempted by individual hospitals. Previous orthopaedic studies have examined the clinical value of these examinations in total hip and knee arthroplasty, lumbar discectomy, knee arthroscopy, and thumb arthroplasty. Those studies demonstrated that routine histologic examination rarely altered the diagnosis and increased the costs. This study examines the clinical value of histologic examination of shoulder arthroscopic specimens. We regard clinical value to include both diagnostic value and cost of the procedure. Methods Between 1989 and 2005, 2144 consecutive shoulder arthroscopies were performed by one surgeon. We retrospectively reviewed the pathology report from every procedure to determine whether the histologic diagnosis affected patient care. We then estimated the total cost of histologic examination in 2005 dollars. Results In all cases, the histologic examination confirmed the findings at arthroscopic surgery. In no case did the histologic findings alter patient care. In 2005 dollars, the total cost of reviewed histologic examinations is estimated to be $160,543. Conclusions Histologic examination of surgical specimens from arthroscopic shoulder surgery does not alter patient care, and it increases costs. On the basis of this study, histologic examination in shoulder arthroscopy should be done at the discretion of the orthopaedic surgeon rather than being mandatory. Level of Evidence Diagnostic Level I . See Instructions to Authors for a complete description of levels of evidence.