Utility of Routine Pathologic Examination for Ganglion Cyst Excision from the Hand and Digits
Carlton J Fernandes, MD, Heather Yee, MD and Felicity Fishman, MD, Loyola University Medical Center, Maywood, IL
INTRODUCTION: Ganglion cysts are mucin filled cysts that originate from joints or tendon sheaths and are the most common soft tissue mass in the hand. It is routine practice at many institutions to send surgically excised ganglion cysts for pathologic analysis. This adds significant cost to the procedure and its benefit is questionable. The purpose of this study was to determine the necessity of routine pathologic examination of ganglion cysts excised from the hand.
MATERIALS AND METHODS: We conducted a retrospective review of 443 patients that underwent ganglion cyst excision from the hand with routine pathologic examination of the specimen between 2012 and 2022 at our institution. The final pathologic diagnosis was compared with the treating surgeonâ€™s clinical diagnosis and the rates of concordant, discrepant and discordant diagnoses were identified. Discrepant diagnoses were defined as different clinical diagnosis and pathologic diagnosis that did not change clinical management. Discordant diagnoses were defined as a different clinical diagnosis and a pathologic diagnosis that altered the treatment plan.
RESULTS: The prevalence of a concordant diagnosis was 96.2% (426 of 443; 95% confidence interval, 94.4% to 98.0%). The prevalence of a discrepant diagnosis was 3.8% (17 of 443; 95% confidence interval, 2.1% to 5.6%), and the prevalence of a discordant diagnosis was zero. The odds ratio was 0.04 for a discrepant diagnosis and zero for a discordant diagnosis.
CONCLUSIONS: Our study suggests abandoning routine pathologic analysis in patients undergoing ganglion cyst excision from hand will not compromise quality of care when the surgeon is able to make a confident diagnosis based on history, examination and operative findings. Discrepant diagnoses were rare and discordant diagnoses did not occur. We recommend pathologic evaluation only when there is uncertainty in the clinical diagnosis.
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