Surgical 

Pathology (Gastrointestinal, Genitourinary, Liver, Pancreas, Renal, Bone & Soft Tissue, Cardiovascular)/ Friday Session 3, November 2, 2012 

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291
Do Clinical-Pathological Communication and Correlation Influence the Diagnosis and Incidence of Osteonecrosis?
Shobha Parajuli, MD, John Fowler, Easwaran Balasubramanian, William R Reinus
Jasvir S Khurana, Temple University Hospital, Philadelphia, PA

Histologic confirmation of osteonecrosis depends on the extent of specimen sampling. We hypothesize that the clinical
diagnosis provided affects the sampling rate. Thus, a correct clinical diagnosis might lead to a more accurate yield of the
pathologic diagnosis of osteonecrosis. Our method included a 2-part retrospective analysis (2007-2011). In part 1, the
pathology databases were queried for a histologic diagnosis of osteonecrosis and correlated with clinical and radiologic
diagnoses. In part 2 the clinical databases were queried for osteonecrosis and correlated with radiologic and pathologic
diagnoses. We found that in part 1, 42 (of 297) arthroplasty specimens had osteonecrosis pathologically. Radiologic imaging,
available in 38 cases (90%), missed the diagnosis in 8 cases (19%). A preoperative diagnosis of osteonecrosis was
communicated in 20 cases (48%). In 7 cases (17%), the diagnosis was missed clinically and radiologically. The number of
blocks submitted for examination ranged from 1 to 36 (mean, 4). In part 2, clinically, 57 (of 263) arthroplasty patients had
osteonecrosis. Of the 57 patients, 32 (56%) were histologically proven to have osteonecrosis; 52 cases (91%) had
osteonecrosis radiologically. The preoperative diagnosis was communicated in 21 cases (37%), of which 14 (67%) were
diagnosed with osteonecrosis. The number of blocks taken ranged from 2 to 11 (mean, 3). The preoperative diagnosis was not
communicated to pathology for 36 patients (63%), of whom 18 (50%) were diagnosed as having osteonecrosis histologically.
The number of blocks submitted in the cases without communication ranged from 1 to 4 (mean, 1). We conclude that
osteonecrosis occurs in about 12% to 20% of our patients (limited by the retrospective nature of the study). The preoperative
diagnosis is communicated in about a third of cases. This knowledge increases sampling and yield of osteonecrosis. A
carefully designed prospective study will obtain the true incidence of osteonecrosis.

Category:
Surgical Pathology

©American Society for Clinical Pathology Am J Clin Pathol2012;138:A291