An audit of breast cancer pathology reporting in Australia in 1995

Abstract

The pathologist's role in breast cancer management is to make a diagnosis and report key items of information essential to treatment planning. To increase national uniformity in procedures and reporting, the Australian Cancer Network's (ACN) Pathology Working Party released specific recommendations about pathology reporting of breast cancer specimens in 1997 (ACN Pathology Working Party, 1997). These recommendations were that all microscopic reports of invasive breast cancer should contain information on tumour type, size, grade, margins of excision, vessel invasion and changes in adjacent breast tissue. For each case of pure ductal carcinoma in situ (DCIS), recommendations were to report tumour size, nuclear grade, necrosis, architecture and calcification and, in addition, a clear statement about the margins of excision.The NHMRC National Breast Cancer Center (NBCC) undertook an audit of pathology reporting of breast cancer cases diagnosed in Australia in 1995, before the release of the recommendations, to measure a baseline for the coverage and completeness of reporting by pathologists in Australia of key items in the ACN Working Party's recommendations (ACN Pathology Working Party, 1997). MATERIALS AND METHODSWe obtained copies of pathology reports, identified by number only, from Australian state and territory cancer registries for cases of invasive breast cancer or DCIS diagnosed in April and May 1995 (and June in the smallest states and territories). In one State, only three of six laboratories agreed to participate, supplying 57% of the cases expected in that State.Completeness of reporting of invasive breast cancer was examined for the key items: tumour size, histological type, histological grade, margins of excision, vessel invasion and changes in the adjacent breast tissue. We examined reporting of changes in adjacent breast tissue in two separate items, the presence or absence of DCIS and changes in adjacent non-neoplastic tissue. In addition, we examined the reporting of nodal status of all breast cancers and the presence or absence of an extensive intraductal component (EIC) associated with infiltrating ductal carcinomas nitric oxide synthase (NOS) (no special type).Reports were classified by the type of diagnostic or therapeutic procedure from which the specimen came. Analyses were based on reports from biopsies and mastectomies which contained information about the breast cancer and excluded fine needle aspirations (FNA), core biopsies and slide reviews.Completeness was defined as the percentage of reports in which a definite statement about an item, either positive or negative, was made. A data dictionary and coding manual and data collection forms were developed for use by three pathology registrars who were the auditors. Typically, the data form sought to classify each Summary To measure the quality of pathology reporting of breast cancer and establish a baseline against which future changes can be measured, we audited item completeness in breast cancer reports in Australia in 1995 before the ...

Audit of Histopathology Reports for Breast Cancer in Aminu Kano Teaching Hospital

“…Prior to the release of the recommendations tumour type and size were found to be given in reports of invasive breast cancer for 93% of women, 70% had, in addition, grade and clearance of the margins while only 28% had all recommended information. 16 In comparison our reports documented tumour type in 92% of cases but only documented tumour size in 50% of cases. The presence or absence of tumour cells in the resection margin, which determines the completeness or otherwise of surgical procedure, was documented in only 64% of our cases.…”

Ductal carcinoma in situ of the breast, a population-based study of epidemiology and pathology

“…Variation in growth rate might also underlie the significant, independent association of architecture with tumour size. The pathology reports from 1998 to 2000 reported DCIS substantially more completely than did earlier Australian reports (Kricker et al, 1999;Giles et al, 2001;Shugg et al, 2002). The Australian Cancer Network addressed pathology reporting of DCIS with extensive consultation among pathologists in the mid-1990s and published recommendations in 1997 (Australian Cancer Network Working Party, 1997(Australian Cancer Network Working Party, 2001.…”

“…Two experienced Cancer Registry personnel extracted information on the type of specimen, size, grade, architecture, presence or absence of necrosis and multifocality of DCIS, and clearance and width of the margins from pathology reports (Kricker et al, 1999).…”

Quality of Histopathological Reporting in Breast Cancer: Results From Four South African Breast Units

“… 23 , 24 Compared with first audits in HICs, only 64.7% had complete reports according to the College of American Pathologists guidelines in an audit from 2010, 25 and only 28% fulfilled all recommendations in an audit from Australia in 1995. 26 Report completeness improves over time, and with ongoing audits, more recent European studies have shown > 94% complete reports according to EUSOMA standards. 27 , 28 …”