The Impact of Immunohistochemistry on Turn-around-Times in Surgical Pathology Reporting
J A Bennett, H Mani. PSMSHMC, Hershey
Background: Rapid turn-around-times (TAT) in surgical pathology are important for optimal patient management. The College of American Pathologists mandates a two-day TAT in over 80% of routine cases. However, immunohistochemistry (IHC) that is often required prior to rendering a diagnosis may potentially increase TAT. To our knowledge, there has not been any systematic analysis of the impact of IHC on TAT. We analyzed the effect of performing IHC on TAT in cases with a diagnosis of dysplasia or carcinoma.
Design: We searched the pathology database of a tertiary care teaching hospital to identify all cases with a diagnosis of dysplasia or carcinoma in a one-year period. TATs were noted for each case and then cases were classified based on whether or not IHC had been performed. Cases were also analyzed by type of specimen (resection vs. biopsy) and by organ system/site. Data was tabulated and analyzed.
Results: A total of 940 cases with a diagnosis of dysplasia or carcinoma were included for study. Most cases were from the genitourinary tract (GU) (308 cases), followed by lower gastrointestinal tract (GIT) (306 cases), lung (192 cases) and upper GIT (134 cases). IHC was performed in 249 (26%) cases. IHCs were performed more frequently in lung (87/192, 45.3%) and upper GIT (59/134, 44%) specimens than in lower GIT (70/306, 22.9%) and GU (33/308, 10.7%) specimens. The average TAT for all cases was 3.12 days, with TAT being significantly higher in cases with IHC (4.11 days) than in those without IHC (2.76 days). IHC increased TAT in both surgical resections (5.17 days with vs. 3.49 days without IHC) and in biopsy specimens (3.05 days with vs. 1.85 days without IHC). TATs with and without the use of IHC by organ system were GU 4.24/2.95, lung 4.25/2.87, lower GIT 4.34/2.56 and upper GIT 3.56/2.53. All the pairs analyzed showed statistically significant increases in TAT following use of IHC (p<0.05). When IHC was used, 80% of samples had a TAT of 3.15 days (2.29 days for biopsy specimens and 4.11 days for surgical resections).
Conclusions: The use of IHC significantly increases TAT in both surgical resection and biopsy specimens with a diagnosis of dysplasia or carcinoma. Our data potentially provides a useful benchmark for additional time required for IHC. Since many specimens require IHC prior to issuing a surgical pathology report, similar studies from other institutions will help evolve TAT recommendations for specimens requiring IHC.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 275, Monday Afternoon