[Diagnostic cost-effectiveness of the skin biopsy in inflammatory diseases of the skin].
BACKGROUND
Inflammatory skin diseases are a very heterogeneous and extensive group of entities whose clinical and pathological diagnosis is difficult. In cases where the clinical diagnosis is doubtful, the histopathological study of one or more lesions can be of great help. The aim of our work is to compare the effectiveness of the histopathological diagnosis in inflammatory skin lesions according to the department performing the biopsy.


METHODS
A retrospective study was carried out on the reports for pathological study requests and the histopathological reports from the year 2003 from the Pathology Department of Hospital Santa María del Rosell. In the reports for the pathological study requests, the following data was assessed: department performing the biopsy, whether or not the type of lesion was stated on the request form, location, evolution and clinical diagnosis. The histopathological diagnoses were reviewed by one of the authors and classified into two major groups: a) specific diagnoses and b) non-specific diagnoses. Five departments took part in performing biopsies on inflammatory skin lesions: Dermatology, General Surgery, Primary Care, Internal Medicine and Gynecology. To better compare the data, we have divided the departments into two groups: 1. Dermatology Department and 2. Non-dermatology departments. We performed a statistical analysis (proportion comparison) of the specific diagnoses between the two groups and among the specific diagnoses of the non-dermatology departments.


RESULTS
The total number of inflammatory skin lesions studied was 97. The Dermatology Department performed 48 biopsies, and the non-dermatology departments performed 49. There was less clinical data in the reports sent by the non-dermatological departments than in those from the Dermatology Department. The pathologist made a specific diagnosis in 77 % of the biopsies performed by the Dermatology Department, compared to 41 % of the biopsies sent by the non-dermatology departments (p < 0.001). There are no statistically significant differences among the specific diagnoses made by the departments that make up the non-dermatology group.


CONCLUSIONS
The histopathological diagnoses made in the biopsies sent from the Dermatology Department are more specific (77 %) than those made in the biopsies performed by the non-dermatology departments (41 %). Thus, biopsies on inflammatory skin lesions should be performed by the Dermatology Department so that diagnostic effectiveness is maximized, and in order to prevent delays and inappropriate treatments that might be harmful to the patient.
Servicio de Anatomía Patológica, Hospital Santa María del Rosell, P. Alfonso XIII 61, 30203 Cartagena, Murcia, Spain.
José
J
García-Solano
Angel
A
López-Avila
Jesús
J
Acosta
Miguel
M
Pérez-Guillermo
D001706:Biopsy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003872:Dermatitis / Q000191:economics* / Q000473:pathology*; D006748:Hospital Departments; D006801:Humans; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*