OBJECTIVE: To assess the utility of foreskin pathology analysis, we evaluated the outcomes and the costs of this practice in patients for whom penile cancer was not suspected. Adult circumcision specimens are routinely sent for pathologic analysis even when penile cancer is not suspected, increasing costs with little benefit. MATERIALS AND METHODS: All adult patients who underwent circumcision between January 2000 and August 2013 at a single institution were evaluated by retrospective chart review. Cases of suspected penile cancer (n = 6) were excluded. We identified cases where foreskin specimens were sent for pathologic analysis and reviewed pathology reports. Our Department of Pathology estimated the cost for evaluation of specimens at $311 per case. RESULTS: A total of 147 circumcisions were performed in patients with no suspicious findings. Pathologic analysis was obtained in 69% (101 of 147) of the cases. Inflammation (58%) was the most common finding. One unsuspected instance of squamous cell carcinoma (Tis) was identified in a patient with human immunodeficiency virus (1 of 147 = 0.7%). The overall cost of pathologic analysis in this study was $31,411. CONCLUSION: In individuals without predisposing immunodeficiency and where cancer was not suspected, we found that pathologic analysis of circumcision specimens identified no additional malignancies. Our data suggest that in this normal risk population, pathologic analysis may not be required. Additionally, forgoing pathology on foreskin specimens in lower risk cases may reduce costs to the health care system.
OBJECTIVE: To assess the utility of foreskin pathology analysis, we evaluated the outcomes and the costs of this practice in patients for whom penile cancer was not suspected. Adult circumcision specimens are routinely sent for pathologic analysis even when penile cancer is not suspected, increasing costs with little benefit. MATERIALS AND METHODS: All adult patients who underwent circumcision between January 2000 and August 2013 at a single institution were evaluated by retrospective chart review. Cases of suspected penile cancer (n = 6) were excluded. We identified cases where foreskin specimens were sent for pathologic analysis and reviewed pathology reports. Our Department of Pathology estimated the cost for evaluation of specimens at $311 per case. RESULTS: A total of 147 circumcisions were performed in patients with no suspicious findings. Pathologic analysis was obtained in 69% (101 of 147) of the cases. Inflammation (58%) was the most common finding. One unsuspected instance of squamous cell carcinoma (Tis) was identified in a patient with human immunodeficiency virus (1 of 147 = 0.7%). The overall cost of pathologic analysis in this study was $31,411. CONCLUSION: In individuals without predisposing immunodeficiency and where cancer was not suspected, we found that pathologic analysis of circumcision specimens identified no additional malignancies. Our data suggest that in this normal risk population, pathologic analysis may not be required. Additionally, forgoing pathology on foreskin specimens in lower risk cases may reduce costs to the health care system.
Authors: Janet R Daling; Margaret M Madeleine; Lisa G Johnson; Stephen M Schwartz; Katherine A Shera; Michelle A Wurscher; Joseph J Carter; Peggy L Porter; Denise A Galloway; James K McDougall; John N Krieger Journal: Int J Cancer Date: 2005-09-10 Impact factor: 7.396
Authors: Eric A Engels; Ruth M Pfeiffer; James J Goedert; Phillip Virgo; Timothy S McNeel; Steven M Scoppa; Robert J Biggar Journal: AIDS Date: 2006-08-01 Impact factor: 4.177
Authors: M C G Bleeker; D A M Heideman; P J F Snijders; S Horenblas; J Dillner; C J L M Meijer Journal: World J Urol Date: 2008-07-08 Impact factor: 3.661
Authors: M Czajkowski; P Wierzbicki; A Kotulak-Chrząszcz; K Czajkowska; M Bolcewicz; J Kłącz; K Kreft; A Lewandowska; B Nedoszytko; M Sokołowska-Wojdyło; Z Kmieć; L Kalinowski; R J Nowicki; M Matuszewski Journal: Int Urol Nephrol Date: 2022-02-01 Impact factor: 2.370