Use of routine histologic evaluation of carpal ganglions

Purpose: Although histologic evaluation is performed routinely on tissue removed during the excision of carpal ganglions, the necessity of this evaluation is uncertain. We evaluated the use of routine histologic evaluation of excised carpal ganglions and performed a cost-benefit analysis. Methods: A retrospective review identified 160 consecutive carpal ganglion (102 dorsal, 58 volar) excisions performed over the past 7 years by 2 surgeons. The preoperative evaluation, surgical findings, and results of the pathologic assessment were evaluated for patients treated with a typical carpal ganglion excision. Results: In 156 of 160 patients the preoperative and intraoperative data were highly suggestive of a carpal ganglion; the pathology reports confirmed the diagnosis in all of these patients. No new information was provided by pathologic assessment. In 4 patients the preoperative and intraoperative assessments were less certain; the pathologic assessments in these patients also were equivocal. No malignancy or condition requiring additional treatment was identified. At our institution the total cost of pathologic evaluation for a carpal ganglion including processing and interpretation fees is $352. Conclusions: Routine histologic examination of excised dorsal and volar carpal ganglions may be unnecessary if the preoperative and intraoperative evaluations are consistent with a diagnosis of carpal ganglion.