Routine Pathological Evaluation of Neuroma Specimens: Is There a Rationale?

ABSTRACT

The routine pathological analysis of therapeutically resected traumatic or postoperative neuroma specimens to confirm diagnosis and rule out occult malignancy remains a controversial issue. Some experts advocate histological analysis of all specimens, and others rely on institutional policy. A retrospective chart review of all patients who underwent excision of clinically diagnosed neuroma over a 6-year period at one institution by a single surgeon was initiated. The correlation of preoperative diagnoses with histological analysis and cost of analyzing specimens individually and over the 6-year period was calculated. Of 515 neuromas resected, 100 were sent for pathological review. Every submitted specimen was histologically confirmed to be a traumatic neuroma, and none of the specimens harbored occult malignancy. Ultimately, no treatment plan was altered after final histology was confirmed. The cost to analyze each specimen (Current Procedural Terminology code 88305) was $495, expressed in U.S. dollars. If every specimen was analyzed, a total cost of $254,925 would have be incurred over the 6-year period. Routine pathological analysis of clinically and intraoperatively confirmed neuromas must be questioned in terms of standard of care requirements given its failure to aid in treatment plans as well as its significant cost to health care systems.

Neuroma - pathology - histology - cost analysis - parasthesias - Tinel's sign - pain

REFERENCES

• 1 Vernadakis A J, Koch H, Mackinnon S E. Management of neuromas.  Clin Plast Surg. 2003;  30 247-268 vii
• 2 Burchiel K J, Johans T J, Ochoa J. The surgical treatment of painful traumatic neuromas.  J Neurosurg. 1993;  78 714-719
• 3 Foltán R, Klíma K, Spacková J, Sedý J. Mechanism of traumatic neuroma development.  Med Hypotheses. 2008;  71 572-576
• 4 Baltalarli B, Demirkan N, Yağci B. Traumatic neuroma: unusual benign lesion occurring in the mastectomy scar.  Clin Oncol (R Coll Radiol). 2004;  16 503-504
• 5 Huang L F, Weissman J L, Fan C. Traumatic neuroma after neck dissection: CT characteristics in four cases.  AJNR Am J Neuroradiol. 2000;  21 1676-1680
• 6 Williams H B. The painful stump neuroma and its treatment.  Clin Plast Surg. 1984;  11 79-84
• 7 Novak C B, van Vliet D, Mackinnon S E. Subjective outcome following surgical management of lower-extremity neuromas.  J Reconstr Microsurg. 1995;  11 175-177
• 8 Novak C B, van Vliet D, Mackinnon S E. Subjective outcome following surgical management of upper extremity neuromas.  J Hand Surg [Am]. 1995;  20 221-226
• 9 Mackinnon S E. Evaluation and treatment of the painful neuroma.  Tech Hand Up Extrem Surg. 1997;  1 195-212
• 10 Ducic I, Moxley M, Al-Attar A. Algorithm for treatment of postoperative incisional groin pain after cesarean delivery or hysterectomy.  Obstet Gynecol. 2006;  108 27-31
• 11 Vora A R, Loescher A R, Craig G T, Boissonade F M, Robinson P P. A light microscopical study on the structure of traumatic neuromas of the human lingual nerve.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;  99 395-403
• 12 Salcedo E, Soldano A C, Chen L et al.. Traumatic neuromas of the penis: a clinical, histopathological and immunohistochemical study of 17 cases.  J Cutan Pathol. 2009;  36 229-233
• 13 Daftari T K, Levine J, Fischgrund J S, Herkowitz H N. Is pathology examination of disc specimens necessary after routine anterior cervical discectomy and fusion?.  Spine (Phila Pa 1976). 1996;  21 2156-2159
• 14 Gulamhuseinwala N, Mackey S, Meagher P, Powell B. Should excised keloid scars be sent for routine histologic analysis?.  Ann Plast Surg. 2008;  60 186-187
• 15 Dellon A L, Kim J, Ducic I. Painful neuroma of the posterior cutaneous nerve of the forearm after surgery for lateral humeral epicondylitis.  J Hand Surg [Am]. 2004;  29 387-390
• 16 Huang L F, Weissman J L, Fan C. Traumatic neuroma after neck dissection: CT characteristics in four cases.  AJNR Am J Neuroradiol. 2000;  21 1676-1680
• 17 Yabuuchi H, Kuroiwa T, Fukuya T, Tomita K, Hachitanda Y. Traumatic neuroma and recurrent lymphadenopathy after neck dissection: comparison of radiologic features.  Radiology. 2004;  233 523-529
• 18 Chhabra A, Williams E H, Wang K C, Dellon A L, Carrino J A. MR neurography of neuromas related to nerve injury and entrapment with surgical correlation.  AJNR Am J Neuroradiol. 2010;  , Feb 4 [Epub ahead of print]
• 19 Furniss D, Swan M C, Morritt D G et al.. A 10-year review of benign and malignant peripheral nerve sheath tumors in a single center: clinical and radiographic features can help to differentiate benign from malignant lesions.  Plast Reconstr Surg. 2008;  121 529-533
• 20 Ducic I, Barrett D M, Al-Attar A. Benign peripheral nerve tumors: treatment algorithm and reconstructive options.  Ann Plast Surg. 2009;  63 156-161