Correlation of clinical, operative, and histopathologic diagnosis of interdigital neuroma and the cost of routine diagnosis

Background: Diagnosis of an interdigital neuroma (IDN) is clinically based on patient symptoms. During operative excision, it is common to send the excised specimen for routine histopathologic examination. The purpose of this study was to evaluate the accuracy of the clinical and intraoperative diagnosis of IDN and correlate these with the histopathologic results of IDN. Methods: Case logs of 3 fellowship-trained foot and ankle surgeons were reviewed to identify all neuroma excisions completed between 1997 and 2014. Charts were reviewed to identify the preoperative clinical diagnosis and intraoperative diagnosis as well as concern for pathology besides a neuroma. All results were compared to final histopathology to identify instances of discordance between diagnoses. A total of 123 patients with 133 neuromas were identified. Results: Of the total 133 neuromas, 5 cases included a clinical or intraoperative concern for a diagnosis other than neuroma. In these 5 instances surgeons accurately identified cysts and rheumatoid nodules. 132 of 133 histopathology reports indicated the presence of nerve tissue in their report. There were no reports of malignancy or abnormal nerve tissue. There were no changes to the postoperative protocol based on histopathology. Conclusion: The clinical, intraoperative, and histopathologic diagnosis of neuroma was in concordance 100% of the time. With a high level of clinical and intraoperative acumen in identifying a neuroma, we believe it is reasonable not to submit the specimen for histopathologic evaluation. In addition, limiting the amount of routine histopathologic evaluation could have saved approximately $480 per case. Level of Evidence: Level IV, case series.