Diagnostic Patterns and Immunohistochemical Stain Usage in Extended Core Prostate Biopsies: Comparisons Between Genitourinary and Non-Genitourinary Pathologists

Abstract

Background: Ancillary immunohistochemical (IPOX) stains are useful in clarifying diagnostically challenging pathologic specimens. In diagnostic workup of prostate needle biopsies, stains for basal cells and α-methylacyl coenzyme A racemase are routinely used to support or refute the diagnosis of prostate cancer. Although useful, these stains add cost and must be used judiciously. There is a lack of firm guidelines establishing the proper utilization of IPOX studies in prostate pathology. Therefore, differences in patterns of stain use and diagnoses may exist, related to expertise of the pathologist. Objectives: The purpose of this study was to compare patterns of diagnoses and IPOX stain use in extended core prostate biopsies between genitourinary (GU) and non-genitourinary (NGU) pathologists in the University of Massachusetts Medical Center Pathology department. Methods: By computer search of medical records, consecutive extended core prostate biopsies (6+ cores) from years 2006-2011 were identified. Using Current Procedural Terminology (CPT) billing data, the number of cores and number of IPOX stains were retrieved. Diagnoses were recorded. Pathologists were divided into two groups based on expertise: genitourinary and non-genitourinary. Differences in the patterns of IPOX use and diagnoses between the two groups were analyzed. Results: GU pathologists diagnose significantly higher rates of prostate cancer (43.8% vs. 35.8%, p Conclusion: Significant differences exist in patterns of IPOX usage between GU and NGU pathologists in extended core prostate biopsy in this single institution study. This suggests the need for guidelines and continuing education focused on this issue to standardize practice, an intervention likely to improve quality of diagnoses and to reduce unnecessary costs.