Utility of Routine Pathologic Examination for Fasciectomy for Dupuytren Contracture

Purpose The objective of this study was to examine the routine pathologic examination of surgical specimens obtained during fasciectomy for Dupuytren contracture.Methods A total of 376 consecutive patients who underwent surgical limited fasciectomy with the excised tissue sent for histopathologic evaluation were identified. Patients were excluded for miscoded procedures, cases where no tissue was sent for pathologic review, and excisions of nodules only. Repeat surgeries in the same patient during the study period were excluded. The rates of concordant, discrepant, and discordant diagnoses were reported. Discrepant diagnoses were defined as different clinical diagnosis and pathologic diagnosis that did not change clinical management. Discordant diagnoses were defined as a different clinical diagnosis and a pathologic diagnosis that altered the treatment plan. The reference standard for final clinical decision-making was the pathologic diagnosis.Results The prevalence of concordant diagnoses was 97.1% (365 of 376), of discrepant diagnoses was 2.9% (11 of 376), and there were no discordant diagnoses. Of 376 patients, 43 underwent previous surgical fasciectomy before the study surgery, and pathologic examination was obtained in 10 of these patients. All 10 patients had concordant diagnoses.Conclusions Our results suggest that routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy. Discrepant diagnoses were encountered infrequently, and rarely in the setting of revision fasciectomy. Discordant diagnoses did not occur. Given the cost associated with pathologic evaluation, this raises the question of whether routine pathologic evaluation is necessary for Dupuytren surgery, where the capability of the treating surgeon to make a clinical diagnosis accurately may render Copyright (c) 2023 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Diagnostic II.

Automated summary

This study aimed to investigate the routine pathologic examination of surgical specimens in patients undergoing fasciectomy for Dupuytren contracture. The results suggest that routine pathologic examination did not impact the treatment plan for patients who underwent limited fasciectomy. Discrepant diagnoses were infrequent, particularly in revision fasciectomy. No discordant diagnoses were found. The cost associated with pathologic evaluation raises questions regarding the necessity of routine pathologic evaluation for Dupuytren surgery, as accurate clinical diagnosis by the treating surgeon may be sufficient.