Quality of pathological reporting for renal cell cancer: implications for systemic therapy, prognostication and surveillance

Abstract

Study Type – Prognosis (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Pathology reporting is an important aspect of cancer care for all solid malignancies and the College of American Pathologists has set forth specific guidelines. Many prognostic nomograms for kidney cancer rely on important pathologic characteristics but it is unknown if current reporting practices permit use of these models. This study shows limitations in the current pathological reporting practices for kidney cancer. Guidelines set forth by the College of American Pathologists are frequently not met and this could limit the use of prognostic models and enrollment into adjuvant trials. Efforts should be made to improve reporting practices by methods such as standard template reporting. OBJECTIVE To evaluate whether current nephrectomy pathology reports are sufficient to allow clinicians to use prognostic nomograms, tailor surveillance, enroll patients into adjuvant trials and select systemic therapy for renal cell carcinoma (RCC). PATIENTS AND METHODS Nephrectomy pathology reports were obtained from the LA County Tumor Registry. Key reporting elements identified by the College of American Pathology (CAP) and utilized in RCC prognostic models were abstracted. Hospital type was coded as community, teaching or cancer centre. Reporting quality was assessed across hospital type and year. RESULTS A total of 317 of 344 sampled reports (92.2%) met the inclusion criteria. Tumour size and margin status were commonly reported. Some 90.2% and 84.2% of reports provided data on histology and Fuhrman grade. Tumour classification was omitted in 27.8%. Microvascular invasion and necrosis were infrequently reported (44.5% and 25.6%, respectively). Only 59.9% of reports met CAP guidelines for tumour classification, margin, size, histology and grade. Two prognostic nomograms (Stage, Size, Grade and Necrosis system and Kattan) could rarely be utilized (15.8% and 12.3%, respectively), whereas the UCLA Integrated Staging System could be used frequently (65.6%). There were discrepancies satisfying CAP guidelines between community, teaching and cancer centre hospitals, with 54.7%, 70.5% and 75% of reports meeting CAP criteria (P= 0.0102). CONCLUSIONS Current RCC pathology reporting fails to satisfy CAP guidelines, does not permit the use of prognostic systems, and may hinder enrollment into adjuvant trials and the selection of systemic therapy. Important reporting discrepancies exist between hospital types, with cancer centres performing best. Quality improvement initiatives to encourage consistent, comprehensive and clinically relevant pathology reports would improve the quality of RCC patient care.

Impact of pathological tumour characteristics in patients with sarcomatoid renal cell carcinoma

“…Unfortunately, while recommended by the College of American Pathologists and potentially useful in prognostication, less than half of nephrectomy pathology reports mention this feature. [21]…”

Pathologic validation of renal cell carcinoma histology in the Surveillance, Epidemiology, and End Results program

“…1). Despite extensive efforts to standardize and educate SEER registry participants performing extraction/ coding, there are inherent issues with pathology assessment, especially in kidney cancer [3]. These are deficiencies that may not be overcome by registry efforts and rely, instead, on education by the pathology community on the essential elements in pathology reporting and current histologic classification.…”

“…Registry medical abstractors are also instructed to gather additional information from the medical records and operative reports. Although the College of American Pathology sets forth specific organ/cancer site guidelines for reporting, significant deficiencies in pathologic reporting exist [2,3]. SEER histology coding greatly depends on the pathologist, but currently, there is no method of pathologic data auditing.…”

The Pathology and Molecular Genetics of Sarcomatoid Renal Cell Carcinoma: A Mini-Review

“…Shuch et al reported that tumor classification was omitted in 28% of pathology reports, which may interfere with the selection of systemic therapy and enrollment into adjuvant clinical trials (33). Various terminologies have been and are being used, such as sarcomatoid differentiation, dedifferentiation (28), component, features, and progression.…”