title: The utility of routine polyp histopathology after endoscopic sinus surgery.
abstract: BACKGROUND
  Routine histopathological assessment is standard practice for nasal polyp specimens obtained during endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Retrospective studies suggest that routine histopathology of nasal polyps shows few unexpected diagnoses that alter patient management. Our objective was to study the use of routine pathological analysis, and its cost to the healthcare system, in a prospective manner.
  
  
  METHODS
  A multicenter prospective assessment was performed from data collected between 2007 and 2013. Only cases of patients undergoing ESS for bilateral CRS were included. We excluded unilateral disease cases, and cases in which diagnoses other than polyps were suspected either preoperatively or intraoperatively. We then compared the preoperative diagnosis with the final histopathology and identified the rate of unexpected pathologies. A cost analysis was performed.
  
  
  RESULTS
  Only 4 of 866 pathological specimens were identified as having a clinically significant unexpected diagnosis. All unexpected pathologies in this series were benign. These 4 cases account for 0.46% of all specimens reviewed. This translates to a number needed to screen of 217 cases of bilateral CRS to discover 1 unexpected pathology. The associated cost for making an unexpected diagnosis was $19,192.73.
  
  
  CONCLUSIONS
  Routine histopathology of nasal polyps in ESS for bilateral CRS with polyps yields few unexpected and management-altering diagnoses. It carries a significant cost to the healthcare system. In cases of bilateral CRS with no other concerning clinical features, clinicians should exercise judgment in submitting polyp specimens for pathology rather than routinely sending polyps for histopathologic analysis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: David H
authors.initials: DH
authors.lastname: Yeh
authors.forename: Jay
authors.initials: J
authors.lastname: Wong
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hoffbauer
authors.forename: Bret
authors.initials: B
authors.lastname: Wehrli
authors.forename: Doron
authors.initials: D
authors.lastname: Sommer
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
mesh_terms: D003365:Costs and Cost Analysis; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D006801:Humans; D033162:Incidental Findings; D009298:Nasal Polyps / Q000191:economics / Q000473:pathology* / Q000601:surgery; D009669:Nose Neoplasms / Q000191:economics / Q000473:pathology; D010212:Papilloma / Q000191:economics / Q000473:pathology; D010255:Paranasal Sinus Neoplasms / Q000191:economics / Q000473:pathology; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics; D012220:Rhinitis / Q000191:economics / Q000473:pathology / Q000601:surgery; D012852:Sinusitis / Q000191:economics / Q000473:pathology / Q000601:surgery
keywords: economics; histopathology; nasal polyps; nose neoplasm; paranasal sinus neoplasm