title: Positive economic and diagnostic accuracy impacts of on-site evaluation of fine needle aspiration biopsies by pathologists.
abstract: OBJECTIVE
  To investigate the impact of pathologists' immediate evaluation of fine needle aspiration biopsy (FNAB) on increasing diagnostic yield and decreasing related expenses.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Grace Hospital, Detroit, Michigan 48235, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Saleh
authors.forename: G
authors.initials: G
authors.lastname: Khatib
mesh_terms: D001706:Biopsy / Q000191:economics; D001707:Biopsy, Needle / Q000191:economics / Q000379:methods*; D006801:Humans; D008505:Medical Staff, Hospital; D010340:Pathology, Surgical / Q000191:economics; D014057:Tomography, X-Ray Computed / Q000191:economics