D.A. Detrisac, R.E. McClain, C.D. Hotari, and C.L. Scribner reply:
We appreciate the interest of our pathologist colleagues in our article. The nine cases that they describe have been reviewed. One patient, with a known history of non-Hodgkin lymphoma, had an arthroscopic acromioplasty and open resection of the distal part of the clavicle. Histologic examination of the distal part of the clavicle revealed findings that were diagnostic of non-Hodgkin lymphoma. None of the other cases involved arthroscopic surgery.
The review of the other eight (non-arthroscopic) cases revealed that five patients (including two patients with pathologic fractures) had known malignancy prior to surgery and that histologic evaluation revealed no new diagnoses. Two new diagnoses of lymphoma and one of atypical lymphoid aggregates, a possible premalignant lesion, were found. These three patients are being followed by their oncologists. No treatment based on the histologic diagnoses has yet been initiated for these three patients.
The source of the payment information is based on Medicare payments in 2005 dollars.
We stand by our conclusion that histologic examination of arthroscopic specimens from shoulder surgery did not influence patient care or provide any new diagnoses. We believe that any unusual arthroscopic findings during surgery should warrant submission for histologic evaluation and that, in these cases, histologic findings in concordance with the arthroscopic findings will provide the best patient care. We also believe that the surgeon should be the one to judge when histologic examination of arthroscopic surgery specimens is indicated.
These letters originally appeared, in slightly different form, on . They are still available on the web site in conjunction with the article to which they refer.