title: Does Routine Pathology Analysis of Adult Circumcision Tissue Identify Penile Cancer?
abstract: OBJECTIVE
  To assess the utility of foreskin pathology analysis, we evaluated the outcomes and the costs of this practice in patients for whom penile cancer was not suspected. Adult circumcision specimens are routinely sent for pathologic analysis even when penile cancer is not suspected, increasing costs with little benefit.
  
  
  METHODS
  All adult patients who underwent circumcision between January 2000 and August 2013 at a single institution were evaluated by retrospective chart review. Cases of suspected penile cancer (n = 6) were excluded. We identified cases where foreskin specimens were sent for pathologic analysis and reviewed pathology reports. Our Department of Pathology estimated the cost for evaluation of specimens at $311 per case.
  
  
  RESULTS
  A total of 147 circumcisions were performed in patients with no suspicious findings. Pathologic analysis was obtained in 69% (101 of 147) of the cases. Inflammation (58%) was the most common finding. One unsuspected instance of squamous cell carcinoma (Tis) was identified in a patient with human immunodeficiency virus (1 of 147 = 0.7%). The overall cost of pathologic analysis in this study was $31,411.
  
  
  CONCLUSIONS
  In individuals without predisposing immunodeficiency and where cancer was not suspected, we found that pathologic analysis of circumcision specimens identified no additional malignancies. Our data suggest that in this normal risk population, pathologic analysis may not be required. Additionally, forgoing pathology on foreskin specimens in lower risk cases may reduce costs to the health care system.
authors: Department of Urology, University of Iowa, Iowa City, IA.
authors: Viral S
authors: VS
authors: Shah
authors: Department of Urology, University of Iowa, Iowa City, IA.
authors: Nathan L
authors: NL
authors: Jung
authors: Department of Urology, University of Iowa, Iowa City, IA.
authors: Daniel K
authors: DK
authors: Lee
authors: Department of Urology, University of Iowa, Iowa City, IA.
authors: Kenneth G
authors: KG
authors: Nepple
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002944:Circumcision, Male; D003365:Costs and Cost Analysis; D055088:Early Detection of Cancer / Q000191:economics; D052816:Foreskin / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult