A Modest Proposal: Prostate Biopsies and In-house Pathology Laboratories

[摘要] As prostate biopsy is one of the most commonly performed office procedures in urology, it is not surprising that it also one of the most controversial. Disagreement exists not only around the optimal prostate-specific antigen (PSA) level at which to perform biopsy and increasing infection rates associated with the procedure, but also around even more basic issues, such as the proper sampling pattern, the number of cores routinely collected, and the optimal approach to collecting and processing the pathology specimens. This last issue is particularly complicated because there are significant financial incentives associated with the way prostate biopsy specimens are submitted and processed. Effectively, Medicare and other payers reimburse pathology laboratories based upon on the number of specimen vials submitted for analysis. In other words, a 12-core biopsy submitted in 12 vials is reimbursed at a higher rate than if the same 12-core biopsy were submitted in 6 or fewer cores. Of course, if this is supported by scientific evidence, it should be considered medically appropriate and cost issues should be secondary. Unfortunately, there are those in Washington, DC, who have published reports wrongly accusing our specialty of performing unnecessary biopsies and submitting pathology specimens in a manner that maximizes profit as opposed to practicing evidence-based medicine and providing high-quality patient care.1,2

[学科分类] 基础医学