title: The usefulness of routine histopathology of bilateral nasal polyps - a systematic review, meta-analysis, and cost evaluation.
abstract: BACKGROUND
  Controversy regarding the usefulness of routine histopathological examination of bilateral nasal polyps removed during endoscopic sinus surgery to identify occult diagnoses still exists. There is a paucity of high-level evidence in the literature.
  
  
  METHODS
  A systematic review and meta-analysis was conducted. Two independent reviewers were used. Pooled proportions and numbers needed to screen were calculated. A cost per life year model was generated based on varying survival benefits and compared to other Canadian screening programs to provide financial context.
  
  
  RESULTS
  Six studies (n = 3772 patients) were included. Of the 3772 patients, 3751 had a pre-operative clinical and post-operative pathological diagnosis of inflammatory nasal polyps. Agreement proportion was 99.44 %. There were 18 unexpected benign and three unexpected malignant diagnoses identified. This translated to a proportion of 0.48 and 0.08 % respectively. Number needed to screen was 210 and 1258 respectively. Pooled proportion for expected findings using a random effect model was 0.99 (95 % CI = 0.99-1). Pooled proportion for unexpected benign findings using a random effect model was 0.00522 (95 % CI = 0.00133-0.01). Pooled proportion for unexpected malignant findings using a random effect model was 0.00107 (95 % CI = 0.000147-0.00283). The cost to pick up one unexpected benign diagnosis was $14557.2. The cost to pick up 1 unexpected malignant diagnosis was $87204.56. Cost per quality life year calculated ranged from 3211.83 to $64677.58 based on varying assumptions on the survival benefits of identifying an unexpected malignancy.
  
  
  CONCLUSIONS
  Routine pathological examination in screening for neoplasia may be low yield, however, no compelling evidence was found to cease such practice. Surgeons should exercise individual judgment in requesting routine examination.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main Street W, Hamilton, ON, L8N 3Z5, Canada. jay.wong@medportal.ca.
authors.forename: Jay S M
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main Street W, Hamilton, ON, L8N 3Z5, Canada. stephanie.hoffbauer@medportal.ca.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hoffbauer
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. dyeh2@uwo.ca.
authors.forename: David H
authors.initials: DH
authors.lastname: Yeh
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Brian.Rotenberg@sjhc.london.on.ca.
authors.forename: Brian
authors.initials: B
authors.lastname: Rotenberg
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main Street W, Hamilton, ON, L8N 3Z5, Canada. michaelkgupta@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McMaster University Medical Centre, 3V1 Clinic, 1200 Main Street W, Hamilton, ON, L8N 3Z5, Canada. ddsommer@hotmail.com.
authors.forename: Doron D
authors.initials: DD
authors.lastname: Sommer
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D006801:Humans; D009298:Nasal Polyps / Q000191:economics / Q000473:pathology / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics*