title: The usefulness of a diagnostic biopsy clinic in a genitourinary medicine setting: recent experience and a review of the literature.
abstract: Genital diseases include a wide range of lesions e.g. infectious and inflammatory. In most cases a clinical diagnosis is reached without the need for a biopsy. Nonetheless, a genital biopsy is safe and may help to confirm the diagnosis. We established a dedicated diagnostic biopsy clinic in 2003. Our objective was to evaluate the effectiveness of our diagnostic biopsy clinic and compare it with other Genitourinary medicine (GUM) clinics in the UK. A retrospective case-note study was performed on 71 patients referred to the biopsy clinic with persistent genital lesions over a 12-month period. Forty-seven biopsies were performed (71% biopsy rate). 43 specimens (92%) were appropriate for histopathological diagnosis. Of these 15% were lichen planus, 15% lichen sclerosis, 10% psoriasis, 7.5% each: eczema, Zoon's and non-specific balanitis. The remainder represented a variety of other conditions. In 27 cases (68%) the clinical diagnosis was consistent with the histological result. The possibility of self-referral and walk-in nature of our GUM service substantially decrease the waiting times for assessment of anogenital disorders. We had a lower biopsy rate for the diagnosis of non-specific balanitis (7.5%) compared with the average rate (21.5%) in 14 UK GUM clinics and good agreement between clinical and histological diagnosis. An empirical first treatment, with simple emollients before biopsy, appears to be a safe clinical approach for the treatment of non-specific balanitis. A multidisciplinary approach (GUM physicians, dermatologists and urologists/gynaecologists) could help prevent unnecessary biopsies and improve correlation between clinical and histological diagnosis.
authors.affiliation: Department of Genitourinary Medicine, Jefferiss Wing, St Mary's Hospital, London W2 1NY, UK. drioulios@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: Palamaras
authors.forename: M
authors.initials: M
authors.lastname: Hamill
authors.forename: G
authors.initials: G
authors.lastname: Sethi
authors.forename: D
authors.initials: D
authors.lastname: Wilkinson
authors.forename: H
authors.initials: H
authors.lastname: Lamba
mesh_terms: D000328:Adult; D001004:Anus Diseases / Q000175:diagnosis* / Q000473:pathology; D001446:Balanitis / Q000473:pathology; D001706:Biopsy; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis*; D005832:Genital Diseases, Male / Q000175:diagnosis*; D005835:Genitalia / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis* / Q000473:pathology