Purpose
The objective of this study was to examine the routine pathologic examination of surgical
specimens obtained during fasciectomy for Dupuytren contracture.
Methods
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.
Results
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.
Conclusions
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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Article info
Publication history
Published online: August 03, 2022
Accepted:
April 13,
2022
Received:
June 29,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
