Review Of Adolescent Gynecomastia Does Not Support Routine Pathological Examination, Reviewed by Miguel Delgado, M.D.  – Dr. John C. Koshy with the Department of Pathology at Baylor College of Medicine and colleagues from Baylor, the University of Southern California, and The Methodist Hospital System conducted an exhaustive examination of hospital records and literature in search of proof that substantiated the routine pathological examination of subcutaneous tissue removed from adolescents that had gynecomastia. The examination included a review of all relevant literature that has been published in the last 45 years. The study also included a review of the hospital charts and records from three major hospitals in Texas of all adolescent patients that had tissue removed due to gynecomastia. The researchers also examined the records of 61 hospitals across the United States that performed at least one procedure for gynecomastia in the last decade using a survey. The study examined males that were 21 years of age and younger. The research found that the average age at which most adolescent men have a procedure for gynecomastia is 17 years of age. The pathology from the 81 patients that underwent a subcutaneous mastectomy for gynecomastia in the Texas hospitals showed no signs of cancer. The literature review found six instances of cancer and five instances of atypical cell growth in the removed tissue. Only seven of the 615 cases of gynecomastia and subsequent pathology from the literature indicated any signs of any type of carcinoma. The literature review is elucidative in that large samples of patients were rare. Those seven patients that did show signs of cancer or the potential for cancer came from studies of single patients or statistically small groups of patients. An abnormal physical exam indicating possible cancer occurred only once. The response to the survey was 36.1 percent. The hospitals that did respond indicated that pathology tests were considered to be not only routine but mandatory in cases of tissue removed from adolescents that had gynecomastia. The researchers argue that the added cost to the patient or patient’s family for the routine pathological examination of fat tissue removed from adolescents with gynecomastia is not supported by the incidence of cancer detected in a study that spanned 45 years of data. The average additional cost of $1,260 is normally not covered by insurance and is considered to be out-of-pocket for the patient or their family. The researchers argue that the psychological benefit of a procedure to remove excess fat tissue in male adolescents that have gynecomastia is substantial. The researchers cite evidence from the records of the Society for Plastic Surgeons for the years 2000, 2007, and 2008 that indicate that only 0.012 percent of the 19,855 procedures for gynecomastia indicated any potential for cancer. The researchers conclude that routine pathological tests for cancer in gynecomastia procedures are not warranted by the observed incidence of cancer in 45 years of study. The study emphasizes that the cost burden to the Medicare and Medicaid systems for pathology as a routine part of a procedure to remove excess fat in gynecomastia cannot be supported. The study does concede that any request for pathology on the part of the patient or the patient’s family should be honored. Article- Breast Cancer Incidence in Adolescent Males Undergoing Subcutaneous Mastectomy for Gynecomastia: Is Pathologic Examination Justified? A Retrospective and Literature Review Koshy, John C. M.D.; Goldberg, Jonathan S. M.D.; Wolfswinkel, Eric M. B.S.; Ge, Yimin M.D.; Heller, Lior M.D.