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. 2016 Dec 19:13:24-28.
doi: 10.1016/j.amsu.2016.12.047. eCollection 2017 Jan.

Routine histological examination of epidermoid cysts; to send or not to send?

Jeyakumar R Apollos  1 , Gregory E Ekatah  1 , Guat Shi Ng  1 , Angus K McFadyen  2 , Stuart C Whitelaw  1
Affiliations

Routine histological examination of epidermoid cysts; to send or not to send?

Jeyakumar R Apollos et al. Ann Med Surg (Lond). .

Abstract

Backround: The diagnosis of epidermoid cyst is seldom in doubt, and associated malignancy extremely rare, yet it is commonplace for the lesion to be sent to the pathology laboratory for analysis. The aim of this study was to evaluate our current practice with regards to diagnostic accuracy among clinicians, and assess risk of not routinely sending suspected epidermoid cysts for histological examination. Potential cost savings were also estimated and calculated.

Methods: Retrospective analysis of clinical and pathology data on all suspected epidermoid cysts excised from a Scottish district general hospital over a 5-year period between January 2011 and October 2015.

Results: Five hundred and thirty-six suspected epidermoid cysts were excised during the study period. Three hundred and ninety-six were sent for histological examination which confirmed a diagnosis of epidermoid cyst in 303 (76.5%) cases. There was good agreement between preoperative suspicion and final histological diagnosis: 80.8% (257/318) among referring clinicians, 81.9% (289/353) among reviewing surgeons, and 88.4% (243/275) where there was preoperative agreement between both. There were no malignant lesions. An average of 80 clinically apparent epidermoid cysts were excised and sent for histology each year at a cost of £4800 per annum.

Conclusion: There was close agreement between clinical and final histological diagnosis of epidermoid cyst. Where a characteristic, odorous, toothpaste-like material is present on transection intra-operatively, the diagnosis is confirmed and the lesion can be discarded. We argue that significant cost savings can be achieved by adopting this approach.

Keywords: Epidermoid cyst; Excision; Health economics; Sebaceous cyst; Skin lesions.

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Figures

Fig. 1
Fig. 1
Study design (GP - General Practitioner).
Fig. 2
Fig. 2
(A–C): Accuracy of diagnosis. A) GP suspicion versus final histological diagnosis. B) Surgeon diagnosis in clinic versus confirmed histological diagnosis. This demonstrates similar accuracy to GPs in identifying epidermoid cysts but much higher accuracy at diagnosing non-epidermoid cyst benign skin lesions. C) Agreement between GP and clinic associated with improved accuracy of diagnosis.
See this image and copyright information in PMC

References

    1. www.bad.org.uk (Accessed 17 July 2016)
    1. Crile G., Jr. Thirteen shortcuts in office surgery. Surg. Clin. N. Am. 1975;55:1025–1029. - PubMed
    1. Paraskevopoulos J.A., Hosking S.W., Johnson A.G. Do all minor excised lesions require histological examination? Discussion paper. J R. Soc Med. 1988;81:583–584. - PMC - PubMed
    1. http://www.london-dermatology-clinic.com/pricing (Accessed 17 July 2016)
    1. Health and Social Care Information Centre. Hospital Episode Statistics, Admitted Patient Care – England, 2011–2012. TODO: clickthrough URL http://www.hscic.gov.uk/hes (Accessed 17th July 2016)