Correlation of Clinical, Operative, and Histopathologic Diagnosis of Interdigital Neuroma and the Cost of Routine Diagnosis

O’Connor, Kathryn M.; Johnson, Jeffrey E.; McCormick, Jeremy J.; Klein, Sandra E.

doi:10.1177/1071100715603118

Cited by 7 publications

(8 citation statements)

References 13 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One study found that in 123 patients with 133 suspected neuromas, the clinical, intraoperative, and histopathologic diagnosis were concordant 100% of the time. 8 Another study also reported 100% concordance between clinical, imaging, and intraoperative diagnosis among 85 patients, with a histopathologic report confirming the diagnosis. 7 In light of increasing cost of delivering health care, financial resources should be allocated responsibly and costs reduced where such reduction does not compromise patient care.…”

Section: Discussionmentioning

confidence: 90%

“…3 Previous studies have demonstrated clinical diagnosis to have a high correlation between clinical, operative, and histopathologic diagnosis. 8 Other studies have also called into question the utility of imaging in the diagnosis of Morton’s neuroma, arguing for its use only in cases with an inconclusive clinical picture. 9 Regardless of the modality used to make the interdigital neuroma (IDN) diagnosis preoperatively, recent studies have also questioned the cost-effectiveness of intraoperative histopathology of an excised neuroma to confirm diagnosis or rule out occult malignancy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Value of Preoperative Imaging and Intraoperative Histopathology in Morton’s Neuroma

et al. 2019

View full text Add to dashboard Cite

Background: Recent studies have demonstrated that clinical diagnosis of Morton’s neuroma is highly correlated with operative and histopathologic diagnosis, whereas others have questioned the cost-effectiveness of intraoperative histopathology of excised specimens. The purpose of this study was to determine the utility of both preoperative imaging and intraoperative histology in the treatment of Morton’s neuroma in making an accurate diagnosis, guiding treatment decisions, and altering clinical outcomes. Methods: A retrospective review was performed on all patients who underwent operative resection suspected Morton’s neuroma with 4 fellowship-trained foot and ankle surgeons between 2007 and 2017. Procedures were excluded from the study if the pathology report was not available for review. Diagnoses were made either by clinical examination and/or by the results of preoperative imaging. All pathology reports were reviewed to determine the final diagnosis, considered the “gold standard.” Postoperative chart notes were reviewed to determine if any treatment regimen was altered based on the pathology report revealing an alternate diagnosis other than Morton’s neuroma. Two hundred eighty-seven procedures in 269 patients with 313 clinically suspected neuromas met inclusion criteria. Results: Of the 313 suspected neuromas, 309 (98.7%) were confirmed Morton’s neuromas on histopathologic examination. For no patient did the results of the pathology report alter the postoperative treatment course. Preoperative imaging results were available for 179 (57.2%) suspected neuromas, with magnetic resonance imaging (MRI) and ultrasonography used to preoperatively image 121 and 71 suspected neuromas, respectively, including 13 using both. The total estimated cost of histopathologic analysis for the cohort was $143 667, and the estimated combined cost of preoperative imaging and intraoperative histopathology in our cohort totaled $278 567. Conclusion: Our study found that the diagnosis of Morton’s neuroma could be made clinically with extreme accuracy and positive predictive value, calling into question the utility and costs of other imaging modalities and intraoperative sampling for histopathologic diagnosis. Level of Evidence: Level IV, retrospective case series.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Value of Preoperative Imaging and Intraoperative Histopathology in Morton’s Neuroma

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The study looked at the results of a total of 123 patients with 133 neuromas and concluded that the clinical, intraoperative, and histopathologic diagnosis of neuroma was in concordance 100% of the time. 2 The authors of the study reiterate that it is reasonable not to submit the specimen for histopathology if intraoperative findings support the clinical diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…The validity of various aspects of clinical examination and imaging in the diagnosis of IN has been previously reported. [2][3][4][5] Excision of the neuroma by dorsal approach is considered to be the gold standard in achieving the desired clinical outcomes. The UK Royal College of Pathologists advocate that all soft tissue lumps, including Morton's neuromas, must to be examined by microscopy.…”

mentioning

confidence: 99%

Is Histopathological Analysis of Interdigital Morton’s Neuroma Necessary?

Mallina

Al-Dadah

Patel

et al. 2016

Foot & Ankle Specialist

View full text Add to dashboard Cite

show abstract

“…Histological examination of a Morton's neuroma reveals extensive inflammation of the perineural tissue with no evidence of tumor formation. [13][14][15] The process is one of a degenerative nature and not a neoplastic one, and the involved nerve histologically demonstrates demyelination, densely packed whorls of collagen (Renaut bodies), and fibrosis of the epineurium and endoneurium.16 This article has been reviewed and accepted for publication. Please note that it has not been copyedited, proofread, or typeset and is not a final version.…”

mentioning

confidence: 99%

Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces - A Retrospective Study

DeHeer¹,

Nanrhe²,

Michael³

et al. 2020

Journal of the American Podiatric Medical Association

View full text Add to dashboard Cite

BACKGROUND: Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and predominantly identified in females. The principal investigator observed Morton's neuromas commonly in both the 2nd and 3rd interspaces in both genders. To the best of our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each gender independently. The present study evaluates Morton's neuroma interspace location and if there is a variation between males and females.METHODS: In this retrospective study, 582 de-identified ProScan magnetic resonance imaging reports, with a diagnosis code for Morton's neuroma (ICD Code 355.6), were obtained from their centralized database. These reports were evaluated for patients scanned from January 2015-April 2016. Incomplete records and those where the radiologist findings were not consistent with Morton's neuroma were eliminated. For the remaining 379 patients, data was collected on several factors such as gender, laterality, history of trauma, plantar plate tear, age and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data was then evaluated statistically utilizing the Pearson Chi-Square and Independent Samples Mann-Whitney U Test with statistical significance deemed p<0.05. RESULTS: No statistically significant distribution between gender and second and third interspace Morton's neuromas were noted. Additionally, right vs left foot, age and history of trauma did not vary between genders in a significant way. Lastly, there was a statistically significant difference between the presence of plantar plate tears between genders. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (34/92, p=0.01).CONCLUSION: Our study found that there was not a statistically significant difference between female and male and Morton's neuromas location, laterality or age.

show abstract

Correlation of Clinical, Operative, and Histopathologic Diagnosis of Interdigital Neuroma and the Cost of Routine Diagnosis

Abstract: Level IV, case series.

Cited by 7 publications

References 13 publications

Value of Preoperative Imaging and Intraoperative Histopathology in Morton’s Neuroma

Value of Preoperative Imaging and Intraoperative Histopathology in Morton’s Neuroma

Is Histopathological Analysis of Interdigital Morton’s Neuroma Necessary?

Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces - A Retrospective Study

Contact Info

Product

Resources

About