Utility of Routine Pathologic Examination for Fasciectomy for Dupuytren Contracture

Published:August 03, 2022DOI:


      The objective of this study was to examine the routine pathologic examination of surgical specimens obtained during fasciectomy for Dupuytren contracture.


      A total of 376 consecutive patients who underwent surgical limited fasciectomy with the excised tissue sent for histopathologic evaluation were identified. Patients were excluded for miscoded procedures, cases where no tissue was sent for pathologic review, and excisions of nodules only. Repeat surgeries in the same patient during the study period were excluded. The rates of concordant, discrepant, and discordant diagnoses were reported. 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. The reference standard for final clinical decision-making was the pathologic diagnosis.


      The prevalence of concordant diagnoses was 97.1% (365 of 376), of discrepant diagnoses was 2.9% (11 of 376), and there were no discordant diagnoses. Of 376 patients, 43 underwent previous surgical fasciectomy before the study surgery, and pathologic examination was obtained in 10 of these patients. All 10 patients had concordant diagnoses.


      Our results suggest that routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy. Discrepant diagnoses were encountered infrequently, and rarely in the setting of revision fasciectomy. Discordant diagnoses did not occur. Given the cost associated with pathologic evaluation, this raises the question of whether routine pathologic evaluation is necessary for Dupuytren surgery, where the capability of the treating surgeon to make a clinical diagnosis accurately may render confirmatory pathologic assessment redundant.

      Type of study/level of evidence

      Diagnostic II.

      Key Words

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        • Desai S.S.
        • Hentz V.R.
        The treatment of Dupuytren disease.
        J Hand Surg Am. 2011; 36: 936-942
        • Mella J.R.
        • Guo L.
        • Hung V.
        Dupuytren contracture: an evidence based review.
        Ann Plast Surg. 2018; 81: S97-S101
        • Shaw Jr., R.B.
        • Chong A.K.S.
        • Zhang A.
        • Hentz V.R.
        • Chang J.
        Dupuytren disease: history, diagnosis, and treatment.
        Plast Reconstr Surg. 2007; 120: 44e-54e
        • Ross D.C.
        Epidemiology of Dupuytren disease.
        Hand Clin. 1999; 15: 53-62
        • Eaton C.
        Evidence-based medicine: Dupuytren contracture.
        Plast Reconstr Surg. 2014; 133: 1241-1251
        • Zhao J.Z.
        • Hadley S.
        • Floyd E.
        • Earp B.E.
        • Blazar P.E.
        The impact of collagenase clostridium histolyticum introduction on Dupuytren treatment patterns in the United States.
        J Hand Surg Am. 2016; 41: 963-968
        • Guitton T.G.
        • van Leerdam R.H.
        • Ring D.
        Necessity of routine pathological examination after surgical excision of wrist ganglions.
        J Hand Surg Am. 2010; 35: 905-908
        • Kocher M.S.
        • Erens G.
        • Thornhill T.S.
        • Ready J.E.
        Cost and effectiveness of routine pathological examination of operative specimens obtained during primary total hip and knee replacement in patients with osteoarthritis.
        J Bone Joint Surg Am. 2000; 82: 1531-1535
        • Boutin P.
        • Hogshead H.
        Surgical pathology of the intervertebral disc. Is routine examination necessary?.
        Spine (Phila Pa 1976). 1992; 17: 1236-1238
        • Kassan M.A.
        • Muñoz E.
        • Laughlin A.
        • Margolis I.B.
        • Wise L.
        Value of routine pathology in herniorrhaphy performed upon adults.
        Surg Gynecol Obstet. 1986; 163: 518-522
        • Netser J.C.
        • Robinson R.A.
        • Smith R.J.
        • Raab S.S.
        Value-based pathology: a cost-benefit analysis of the examination of routine and nonroutine tonsil and adenoid specimens.
        Am J Clin Pathol. 1997; 108: 158-165
        • Wolkomir A.F.
        • Barone J.E.
        • Moser R.L.
        Selective microscopic examination of gallbladders, hernia sacs, and appendices.
        Am Surg. 1991; 57: 289-292
        • Kamal R.N.
        • Behal R.
        Clinical care redesign to improve value in carpal tunnel syndrome: a before-and-after implementation study.
        J Hand Surg Am. 2019; 44: 1-8
        • Kamal R.N.
        • Kakar S.
        • Ruch D.
        • et al.
        Quality measurement: a primer for hand surgeons.
        J Hand Surg Am. 2016; 41: 645-651
        • Fraser C.G.
        • Woodford F.P.
        Strategies to modify the test-requesting patterns of clinicians.
        Ann Clin Biochem. 1987; 24: 223-231
        • van Walraven C.
        • Goel V.
        • Chan B.
        Effect of population-based interventions on laboratory utilization: a time-series analysis [published correction appears in JAMA 2000 Jan 26;283(4):481].
        JAMA. 1998; 280: 2028-2033
        • Winkens R.A.
        • Ament A.J.
        • Pop P.
        • Reniers P.H.
        • Grol R.P.
        • Knottnerus J.A.
        Routine individual feedback on requests for diagnostic tests: an economic evaluation.
        Med Decis Making. 1996; 16: 309-314
        • Fitzgibbons P.
        • Cleary K.
        CAP offers recommendations on selecting surgical specimens for examination.
        CAP Today. 1996; 10: 40
        • Bullough P.G.
        • Dorfman H.D.
        The principle of utility in cost-based contemporary medical care.
        J Bone Joint Surg Am. 1998; 80: 311-312
        • Sanjuan-Cervero R.
        • Carrera-Hueso F.J.
        • Vaquero-Perez M.
        • Montaner-Alonso D.
        Recurrent Dupuytren disease after fasciectomy and collagenase injection are histologically indistinguishable.
        J Hand Surg Eur Vol. 2020; 45: 508-512
        • Wade R.
        • Igali L.
        • Figus A.
        Skin involvement in Dupuytren disease.
        J Hand Surg Eur Vol. 2016; 41: 600-608
        • Kadhum M.
        • Smock E.
        • Khan A.
        • Fleming A.
        (2017). Radiotherapy in Dupuytren disease: a systematic review of the evidence.
        J Hand Surg. Eur Vol. 2017; 42: 689-692