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Variation in Pathology Examination of Extended Core Prostate Biopsies: A CRN Pilot Project

Publication Date

4-30-2015

Keywords

prostate biopsy, pathology

Abstract

Background/Aims: Extended core prostate biopsy (ECPB) removing 10–12 tissue cores is the standard of care in men investigated for prostate cancer; however, the manner of pathologic examination varies. Urologists may process cores by laterality into two specimen jars, or separate each core into 12 specimens for pathologic review. Considering the high volume of ECPBs performed annually, varying strategies of submitting specimens for review could lead to variations of over $1 billion in health care expenditures. We will examine the association between number of jars submitted for pathologic review and rates of prostate cancer detection and equivocal diagnoses.

Methods: We are conducting a pilot project at two Cancer Research Network (CRN) sites –– Meyers Primary Care Institute (MPCI) in Worcester, MA, and Marshfield Clinic (MCRF) in Marshfield, WI –– to determine patterns of processing ECPB tissue cores for pathologic review in men aged 30–95 years who underwent ECPB between 2008–2011. ECPBs and subsequent pathology services were identified in the CRN virtual data warehouse (VDW). Prostate cancer diagnoses were identified in VDW tumor files and equivocal diagnoses as repeat ECPBs within 7–180 days of the initial biopsy. Site-specific methods for identifying and validating jar number have been developed.

Results: To establish this pilot study, we constructed datasets using the CRN VDW, discovered new variables in raw claims data, and performed medical record abstraction to validate new variables. At MPCI, 731 ECPBs were conducted 2008–2011, with a median of 2 jars per ECPB (range: 1–36). Jar number was extracted from raw claims data and validated through selected medical chart review. At MCRF, 902 ECPBs were conducted 2008–2011, with a median of 3 jars per ECPB (range: 1–12). A jar number algorithm that partly includes manual abstraction for some patients was developed and validated through a systematic review of all identified biopsy patients. Additional analyses linking jar number to patient outcomes are ongoing.

Discussion: A two-site CRN pilot project was successfully developed to investigate the association between jar number for ECPB pathologic review and patient prostate cancer outcomes. Combining VDW and raw claims data, we have established a strong foundation for future research in this area.

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Submitted

April 7th, 2015

Accepted

April 28th, 2015