title: Value-based analysis of routine pathologic septal and inferior turbinate specimens.
abstract: OBJECTIVE
  To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, or directed septal biopsies were excluded from review.
  
  
  RESULTS
  A total of 1194 pathology reports were reviewed from 1172 individual patients. This included histopathologic evaluation of 1194 septal cartilage and bone specimens and 714 inferior turbinate specimens. None of the patients had unanticipated histopathologic findings that were clinically significant.
  
  
  CONCLUSIONS
  Many surgeons obtain histopathologic diagnoses on all tissue removed from a patient. Based on our institutional case series, histopathology of the septum and inferior turbinates in routine sinonasal cases may not be necessary. A value-based approach to processing grossly unremarkable septal and turbinate tissue by waiving histologic processing and subsequent microscopic evaluation could provide significant cost savings.
authors: Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. jdaniero@gmail.com
authors: James J
authors: JJ
authors: Daniero
authors: Jaemi S
authors: JS
authors: Chu
authors: Brian J
authors: BJ
authors: O'Hara
authors: Edmund A
authors: EA
authors: Pribitkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000473:pathology*; D009300:Nasal Septum / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D014420:Turbinates / Q000473:pathology* / Q000601:surgery