Impact of General Versus Sub-Specialization Pathology Practice Models on Immunohistochemistry Utilization
Reza Alaghehbandan, Khaldoon Aljerian, Heather S Currens, Beverley A Carter, Stephen S Raab. Memorial University of Newfoundland, St. John's, NL, Canada
Background: Immunohistochemistry (IHC) plays an important role in pathology practice, particularly in the sub-specialties of oncologic pathology, neuropathology, and hematopathology. There is a limited knowledge on the impact of various pathology practice models (i.e., general vs. specialty) on IHC utilization rate.
Design: We performed a cross-sectional analysis of aggregate surgical pathology specimen case data collected during a 7-month period (January to July 2011) encompassing pre- and post-general versus specialization sign-out practice models. In the general practice model 16 pathologists signed out the majority of all cases and in the subspecialty model, 2-4 pathologists signed out each major subspecialty. We compared IHC utilization metrics (e.g., slides and antibodies per month) for the two models. We specifically evaluated the use of specific IHC protocols (e.g., melanoma protocol in patients who had pigmented skin lesions) and individual IHC stains.
Results: During the study period, 707,736 glass slides were produced (mean number of 228 slides per day and 10,105 slides per month) and 24,097 IHC slides were produced (mean number of 115 IHC slides per day and 3,442 slides per month). The IHC utilization rate was higher in general practice (29.5%) compared to subspecialty practice (25.0%) (P < .0001). The use of IHC protocols differed in the two practice models; for example, the IHC melanoma protocol was utilized more in the general practice model compared to sub-specialty practice model (P = .001). Individual stain utilization differed in the two practice models; for example, a pan-keratin stain was the most common IHC stain utilized in subspecialty practice (P < .001), while 34βE12 stain was the most frequent stain used in the general model.
Conclusions: In our institution, subspecialty practice had a lower IHC utilization frequency compared to general practice. We hypothesize that subspecialty practice results in a higher level of standardization in IHC ordering, which may be secondary to diagnostic certainty, knowledge of established IHC protocols, and experience with common and uncommon subspecialty diagnostic dilemmas.
Category: Quality Assurance
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 303, Monday Morning