"Looking grossly might seem like next best alternative to the expense of putting every specimen under the microscope," Thorne says. "But it may be the worst of both worlds the data show you're unlikely to find anything, but you're still incurring significant expense."
While better at identifying disease, microscopic examination also turned up few unsuspected problems. The incidence is so low that the researchers estimated over $750,000 would need to be spent for every case of lymphoma found.
Out of 1,066 microscopic examinations, 18 cases of disease were found, all of which were suspected before surgery either because a patient was known to be at higher risk because they had previously received an organ transplant or a surgeon noticed something suspicious and requested additional scrutiny.
No one is suggesting that discovering hidden cancers and other diseases isn't important, Thorne says. The question is what we might be giving up elsewhere in order to find those rare cases.
Part of the problem is a disconnect between the service and the payment. For a parent with insurance, there might be no additional out-of-pocket cost to have their child's tonsil's examined under a microscope. But as a society we have to balance those individual desires with the burden on the overall system, Thorne explains.
"If we're going to make a rational decision say, 'I don't care how much it costs, missing a lymphoma in a child is unacceptable' then we should be doing microscopy all the time. If we're just doing gross analysis, we're still spending a lot of money, yet we know we're unlikely to find anything that way."
Still, routine analysis has some non-clinical benefits, such as its use in training pathologists, the authors note.
Jonathan McHugh, M.D., an assistant professor of pathology at U-M Medical School and one of the study's a
|Contact: Ian Demsky|
University of Michigan Health System