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Pathology Evaluation of Reduction Mammaplasty Specimens and Subsequent Diagnosis of Malignant Breast Disease: A Claims-Based Analysis

  • Erika D. SearsEmail author
  • Yu-Ting Lu
  • Ting-Ting Chung
  • Adeyiza O. Momoh
  • Kevin C. Chung
Original Scientific Report
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Abstract

Background

This study aimed to measure the use of pathology evaluation of breast specimens among patients undergoing reduction mammaplasty and assess rates of new diagnoses of breast disease and associated cost.

Methods

We analyzed the Truven MarketScan Databases from 2009 to 2015 to identify adult female patients undergoing reduction mammaplasty for macromastia. We recorded patient age, rates of obtaining pathology evaluation, new diagnoses of benign or malignant breast disease after pathology evaluation, and total cost for the surgery encounter.

Results

Among 17,738 macromastia patients undergoing reduction mammaplasty, 91.3% (n = 16,193) received pathology evaluation. Pathology evaluation rates were clinically similar across age groups <70 years (90.8–92.1%) and slightly lower for patients ≥70 (85.0%). Among 6987 patients less than 40 years who received pathology evaluation, 0.06% (n = 4) were subsequently diagnosed with malignant breast disease within 3 months, compared to 0.23% in the entire cohort (n = 37/16,193). Pathology claims resulted in an added $307 (SD 251) on average for the breast reduction surgery encounters.

Conclusions

Breast tissue after reduction mammaplasty is routinely submitted for pathology evaluation, without consideration of age-based risk for breast cancer. Routine pathology evaluation of breast tissue in patients in lower risk age groups (less than 40 years) required an additional $536,000 on average to detect a single occult breast cancer compared to an added $85,600 to detect a new malignancy in patients 40 years and older. Clinicians and policy makers should consider whether routine pathology evaluation of breast tissue should be individualized based on risk factors for breast cancer.

Notes

Acknowledgements

Dr. Erika D. Sears is supported in part by a Career Development Award Number IK2 HX002592 from the United States (U.S.) Department of Veterans Affairs Health Services R&D (HSRD) Service. The funding organizations had no role in the design and conduct of the study, including collection, management, analysis, and interpretation of the data.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    American Society of Plastic Surgeons National Plastic Surgery Statistics. 2016 Cosmetic & Reconstructive Procedure Trends. https://www.plasticsurgery.org/documents/News/Statistics/2016/2016-plastic-surgery-statistics-report.pdf. Accessed 20 October 2017
  2. 2.
    Ambaye AB, Goodwin AJ, MacLennan SE et al (2017) Recommendations for pathologic evaluation of reduction mammoplasty specimens: a prospective study with systematic tissue sampling. Arch Pathol Lab Med 141:1523–1528CrossRefGoogle Scholar
  3. 3.
    Merkkola-von Schantz PA, Jahkola TA, Krogerus LA et al (2017) Should we routinely analyze reduction mammaplasty specimens? J Plast Reconstr Aesthet Surg 70:196–202CrossRefGoogle Scholar
  4. 4.
    Uson Junior PLS, Callegaro Filho D, Bugano DDG et al (2018) Incidental findings in reduction mammoplasty specimens in patients with no prior history of breast cancer. an analysis of 783 specimens. Pathol Oncol Res 24:95–99CrossRefGoogle Scholar
  5. 5.
    Kalliainen LK, Committee AHP (2012) ASPS clinical practice guideline summary on reduction mammaplasty. Plast Reconstr Surg 130:785–789CrossRefGoogle Scholar
  6. 6.
    Tang CL, Brown MH, Levine R et al (1999) Breast cancer found at the time of breast reduction. Plast Reconstr Surg 103:1682–1686CrossRefGoogle Scholar
  7. 7.
    Carlson GW (2016) The management of breast cancer detected by reduction mammaplasty. Clin Plast Surg 43:341–347CrossRefGoogle Scholar
  8. 8.
    Rees TD, Coburn R (1972) Breast reduction: is it an aid to cancer detection? Br J Plast Surg 25:144–146CrossRefGoogle Scholar
  9. 9.
    Bondeson L, Linell F, Ringberg A (1985) Breast reductions: what to do with all the tissue specimens? Histopathology 9:281–285CrossRefGoogle Scholar
  10. 10.
    Guitton TG, van Leerdam RH, Ring D (2010) Necessity of routine pathological examination after surgical excision of wrist ganglions. J Hand Surg Am 35:905–908CrossRefGoogle Scholar
  11. 11.
    McKeon K, Boyer MI, Goldfarb CA (2006) Use of routine histologic evaluation of carpal ganglions. J Hand Surg Am 31:284–288CrossRefGoogle Scholar
  12. 12.
    Culp JA, Hartigan BJ, Stern PJ (2001) A brief note. Ask yourself, why? A cost effective look at routine pathologic examination of specimens using the trapezium. J Bone Jt Surg Am 83(5):722–724CrossRefGoogle Scholar
  13. 13.
    Kocher MS, Erens G, Thornhill TS et al (2000) Cost and effectiveness of routine pathological examination of operative specimens obtained during primary total hip and knee replacement in patients with osteoarthritis. J Bone Jt Surg Am 82(11):1531–1535CrossRefGoogle Scholar
  14. 14.
    Lin MM, Goldsmith JD, Resch SC et al (2012) Histologic examinations of arthroplasty specimens are not cost-effective: a retrospective cohort study. Clin Orthop Relat Res 470:1452–1460CrossRefGoogle Scholar
  15. 15.
    Pitanguy I, Torres E, Salgado F et al (2005) Breast pathology and reduction mammaplasty. Plast Reconstr Surg 115:729–734CrossRefGoogle Scholar
  16. 16.
    The Royal College of Pathologists. Histopathology and cytopathology of limited or no clinical value. 2nd edn. https://www.rcpath.org/. Accessed 6 March 2018
  17. 17.
    The Joint Commission. Standards FAQ Details. Quality System Assessment for Nonwaived Testing (QSA). https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFAQId=786&StandardsFAQChapterId=104&ProgramId=0&ChapterId=0&IsFeatured=False&IsNew=False&Keyword=. Accessed 8 October 2018
  18. 18.
    Kerrigan CL, Slezak SS (2013) Evidence-based medicine: reduction mammaplasty. Plast Reconstr Surg 132:1670–1683CrossRefGoogle Scholar
  19. 19.
    MarketScan White Paper. The Truven Health MarketScan Databases for heatlh services researchers. https://truvenhealth.com/portals/0/assets/2017_MarketScan_Databases_Health_Services_Researchers.pdf. Accessed 15 November 2018
  20. 20.
    Siegel JE, Weinstein MC, Russell LB et al (1996) Recommendations for reporting cost-effectiveness analyses. panel on cost-effectiveness in health and medicine. JAMA 276:1339–1341CrossRefGoogle Scholar
  21. 21.
    Dotto J, Kluk M, Geramizadeh B et al (2008) Frequency of clinically occult intraepithelial and invasive neoplasia in reduction mammoplasty specimens: a study of 516 cases. Int J Surg Pathol 16:25–30CrossRefGoogle Scholar
  22. 22.
    Ishag MT, Bashinsky DY, Beliaeva IV et al (2003) Pathologic findings in reduction mammaplasty specimens. Am J Clin Pathol 120:377–380CrossRefGoogle Scholar
  23. 23.
    Kakagia D, Fragia K, Grekou A et al (2005) Reduction mammaplasty specimens and occult breast carcinomas. Eur J Surg Oncol 31:19–21CrossRefGoogle Scholar
  24. 24.
    Colwell AS, Kukreja J, Breuing KH et al (2004) Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg 113:1984–1988CrossRefGoogle Scholar
  25. 25.
    Viana GA, Pitanguy I, Torres E (2005) Histopathological findings in surgical specimens obtained from reduction mammaplasties. Breast 14:242–248CrossRefGoogle Scholar
  26. 26.
    Ozmen S, Yavuzer R, Latifoglu O et al (2000) Coincidental breast carcinoma detection in reduction mammaplasty specimens. Plast Reconstr Surg 106:1219–1220CrossRefGoogle Scholar
  27. 27.
    Clark CJ, Whang S, Paige KT (2009) Incidence of precancerous lesions in breast reduction tissue: a pathologic review of 562 consecutive patients. Plast Reconstr Surg 124:1033–1039CrossRefGoogle Scholar
  28. 28.
    Kyriopoulos E, Kakagia D, Zapandioti P et al (2012) Pathologic findings in breast reduction specimens: detection of occult premalignant and cancerous lesions. Onkologie 35:583–586CrossRefGoogle Scholar
  29. 29.
    Merkkola-von Schantz PA, Jahkola TA, Krogerus LA et al (2017) Reduction mammaplasty in patients with history of breast cancer: the incidence of occult cancer and high-risk lesions. Breast 35:157–161CrossRefGoogle Scholar
  30. 30.
    Hassan FE, Pacifico MD (2012) Should we be analysing breast reduction specimens? A systematic analysis of over 1,000 consecutive cases. Aesthet Plast Surg 36:1105–1113CrossRefGoogle Scholar
  31. 31.
    Ambaye AB, MacLennan SE, Goodwin AJ et al (2009) Carcinoma and atypical hyperplasia in reduction mammaplasty: increased sampling leads to increased detection. Prospect study Plast Reconstr Surg 124:1386–1392CrossRefGoogle Scholar
  32. 32.
    Slezak S, Bluebond-Langner R (2011) Occult carcinoma in 866 reduction mammaplasties: preserving the choice of lumpectomy. Plast Reconstr Surg 127:525–530CrossRefGoogle Scholar
  33. 33.
    Rudolph R, Niedbala AR (2003) Surgical management of the patient with invasive carcinoma discovered at reduction mammoplasty. Am Surg 69:1003–1005Google Scholar
  34. 34.
    Koltz PF, Girotto JA (2010) The price of pathology: is screening all breast reduction specimens cost effective? Plast Reconstr Surg 125:1575–1576CrossRefGoogle Scholar
  35. 35.
    Keshtgar M, Hamidian Jahromi A, Davidson T et al (2009) Tissue screening after breast reduction. BMJ 338:b630CrossRefGoogle Scholar
  36. 36.
    Choosing Wisely. An Initiative of the ABIM Foundation. http://www.choosingwisely.org/wp-content/uploads/2015/01/Choosing-Wisely-Recommendations.pdf. Accessed 10 October 2018
  37. 37.
    Greco R, Noone B (2017) Evidence-based medicine: reduction mammaplasty. Plast Reconstr Surg 139:230e–239eCrossRefGoogle Scholar

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2019

Authors and Affiliations

  • Erika D. Sears
    • 1
    • 2
    • 3
    Email author
  • Yu-Ting Lu
    • 1
  • Ting-Ting Chung
    • 4
  • Adeyiza O. Momoh
    • 1
  • Kevin C. Chung
    • 1
    • 3
  1. 1.Department of Surgery, Section of Plastic SurgeryMichigan MedicineAnn ArborUSA
  2. 2.Veterans Affairs Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborUSA
  3. 3.Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  4. 4.Center for Big Data Analytics and Statistics and Division of Rheumatology, Allergy and ImmunologyChang-Gung Memorial HospitalTaoyuanTaiwan

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