To The Editor:
The findings reported in the article, "The Clinical Value of Histologic Examination in Shoulder Arthroscopy" (2008;90:281-3), by McClain et al., are discordant with our experience. We are the pathology department that interprets the histologic material from two of the three institutions listed in the article. In the past twelve months, there have been nine cases of malignancy or probable malignancy that have been diagnosed on the basis of histologic examination of orthopaedic specimens, including two shoulder cases from one of the authors of this article. Neither the tissue request slip from the surgeon nor the history charts in the pathology department indicated current or prior malignancy in these patients. These specimens came from patients between the ages of sixty-one and eighty-eight years and included arthroplasty specimens as well as arthroscopic shavings. Tissue sites included the hip, knee, shoulder, and lumbar spine. The diagnoses in these cases included metastatic carcinoma, lymphoma, probable lymphoma, and one case of systemic mastocytosis. The total number of surgical pathology specimens from all surgical procedures in our community hospital averages 16,000 per year.
We were not involved in the result comparison of the histologic findings with the clinical or intraoperative diagnosis. We can state, however, that the information regarding payment is somewhat misleading given the insurance mix in our area of Michigan. Our average reimbursement is well below that listed in the article's calculations.
The controversy regarding the submission of specimens to the pathology department should be based on patient care. When good patient care is reduced to a monetary standard, then patient care and patient safety may become secondary. The diagnoses rendered in the above-mentioned cases required histologic examination of these tissues. Even experienced surgeons have been surprised by unexpected findings in the most innocuous tissue samples that have altered the course of the patient's care.