Limited Histopathology Adequate for Evaluating Routine Cholesteatoma Cases

Are routine histopathologic diagnoses of cholesteatoma specimens necessary and cost effective?

Background: Treating chronic otitis media with or without cholesteatoma through tympanomastoidectomy is common, generating surgical specimens that must be examined to decide whether or not they should undergo pathologic evaluation. These study authors sought to explore the clinical utility and cost effectiveness of routine cholesteatoma histopathologic evaluation in the same way that routine tonsillectomy histopathologic evaluation has been questioned.

Study design: Retrospective chart analysis of patients undergoing tympanomastoidectomy for chronic otitis media, with specimens submitted for pathologic review between January 1, 2010 and October 26, 2011. The 2012 Medicare reimbursement rate of $61.95 was used for cost analysis.

Setting: Providence Hospital and Medical Center, Southfield, Mich.

Synopsis: The study included 178 consecutive cases of tympanomastoidectomy for chronic otitis media with surgical specimens submitted for histopathologic review. Each histopathologic diagnosis was compared with the surgeon’s intraoperative gross findings in the operative report. Of the 178 cases, 162 of the surgeon’s operative and pathology reports agreed that cholesteatoma was present. In 14 cases, the surgeon’s operative and pathology reports agreed that pathology other than cholesteatoma, such as granulation tissue or a glomus tumor, was present. In two cases, the surgeon suspected cholesteatoma, but the pathologist disagreed, stating that submitted tissue was mucosa or inflammatory tissue. No malignancies were found, and there were no instances of the pathology report disagreeing with the surgeon’s report stating cholesteatoma was present. The total annual cost for cholesteatoma histopathologic review would be $1,115,100.

Bottom line: There is evidence to limit or avoid routine histopathologic evaluation of cholesteatoma and instead selectively utilize histopathology in cases where pathology other than cholesteatoma is suspected.

Citation: Kircher ML, Thottam PJ, Bojrab DI, Babu SC. Utility and cost analysis of cholesteatoma histopathologic evaluation. Laryngoscope. 2014:124:538-540.