Review of outside pathology prior to treatment of cervical intraepithelial neoplasia: a cost analysis

Heather R. Williams, Medical College of Georgia at Augusta University, Department of Obstetrics and Gynecology, Augusta, GA
Alison C. Agner, Colorado Permanente Medical Group Obstetrics, Denver, CO
Colleen K. Stockdale, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA


Objectives: Academic institutions routinely require in-house review of pathology prior to treatment. However, it is unclear if pathology review is beneficial for the management of patients referred for cervical intraepithelial neoplasia (CIN). This study aims to determine if review of outside pathology for CIN at an academic medical center resulted in a change in the treatment plan and the associated cost for pathology review.

Methods: A retrospective chart review of patients referred for treatment of CIN, including review of outside cytology and histology was performed from January 1 to December 31, 2007 after obtaining IRB approval. Data was analyzed to determine whether pathology diagnosis was changed from the outside facility interpretation; classified as minor if there was no change in clinical management and major if there was a change in treatment as a result of the internal review. Demographic and pathology information was collected from electronic medical records. Billing information was collected from the finance department. Data were analyzed using descriptive statistics.

Results: Seventy-eight patients were identified of which 54 had outside pathology slides available for pathology review. Eleven had a minor change in the pathology diagnosis (20%). None of the changes in pathology diagnosis resulted in a change in treatment plan (major). The total pathology review charge was $14,679 for the 54 patients, with an average charge per patient of $272. Nine of the cases were charged twice to reflect the opinion of two separate pathologists (internal consultation). Of the 54 patients, 23 (43%) had state supported insurance, 24 (44%) had private insurance, and 7 (13%) were self-pay. A total of $12,969.29 was not covered/paid (88% of all charges) and thus absorbed by the institution.

Conclusion: Mandatory review of outside pathology is a common practice. However, it may not be beneficial in all clinical situations. While this pathology review for CIN resulted in minor changes for 20% of patients referred to our academic/tertiary institution, it did not affect any treatment recommendations. Pathology review did increase the cost burden to the institution and the patient.