The usefulness of routine histopathology of bilateral XXXX - a systematic review, meta-analysis, and cost evaluation.

@entity1 @entity480 @entity5 @entity8637
BACKGROUND: Controversy regarding the usefulness of routine histopathological examination of bilateral @entity480 removed during endoscopic sinus surgery to identify occult diagnoses still exists. There is a paucity of high-level evidence in the literature. METHODS: A systematic review and meta-analysis was conducted. Two independent reviewers were used. Pooled proportions and numbers needed to screen were calculated. A cost per life year model was generated based on varying survival benefits and compared to other Canadian screening programs to provide financial context. RESULTS: Six studies (n   =   3772 @entity1 ) were included. Of the 3772 @entity1 , 3751 had a pre-operative clinical and post-operative pathological diagnosis of @entity480 . Agreement proportion was 99.44  %. There were 18 unexpected benign and three unexpected malignant diagnoses identified. This translated to a proportion of 0.48 and 0.08  % respectively. Number needed to screen was 210 and 1258 respectively. Pooled proportion for expected findings using a random effect model was 0.99 (95  % CI   =   0.99-1). Pooled proportion for unexpected benign findings using a random effect model was 0.00522 (95  % CI   =   0.00133-0.01). Pooled proportion for unexpected malignant findings using a random effect model was 0.00107 (95  % CI   =   0.000147-0.00283). The cost to @entity8637 up one unexpected benign diagnosis was  14557.2. The cost to @entity8637 up 1 unexpected malignant diagnosis was  87204.56. Cost per quality life year calculated ranged from 3211.83 to  64677.58 based on varying assumptions on the survival benefits of identifying an unexpected @entity5 . CONCLUSIONS: Routine pathological examination in screening for @entity5 may be low yield, however, no compelling evidence was found to cease such practice. Surgeons should exercise individual judgment in requesting routine examination.
