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 release of specific recommendations from the Australian Cancer Network. Tumour type and size were 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. The most complete items in reports were histological type of breast cancer (99.6% of cases), tumour size (94%, 95% confidence interval (CI) 92–95) and margins of excision (87%, 95% CI 85–89). Histological grade (84%, 95% CI 82–86 of cases) and presence or absence of ductal carcinoma in situ (DCIS) (79%, 95% CI 77–81) were less complete and vessel invasion (61%, 95% CI 58–63) and changes in non-neoplastic breast tissue adjacent to the breast cancer (68%, 95% CI 66–71) the least complete. Less than half the reports of DCIS reported on tumour size (49%, 95% CI 42–57), presence or absence of necrosis (41%, 95% CI 34–49) or nuclear grade (39%, 95% CI 31–46). Around 1500 reports were identified as issued by 147 laboratories and 392 pathologists; 69% of pathologists issued fewer than two reports a month in the audit. We concluded that infrequency of reporting may have contributed to incompleteness of reporting. In addition, we found significant variation across Australian states with some indication that reporting was consistently poor in one state. The audit highlighted areas for improvement for breast cancer reporting in Australia. Research evidence suggests that multifaceted strategies are needed to assist practitioners with implementing more uniform reporting standards.
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References
ACN Pathology Working Party (1997). The Pathology Reporting of Breast Cancer. A Guide for Pathologists, Surgeons and Radiologists. Sydney: Australian Cancer Network
Armitage, P. & Berry, G. (1991). Statistical Methods in Medical Research. Blackwell Scientific: Oxford
Bero, L. A., Grilli, R., Grimshaw, J. M., Harvey, E., Oxman, A. D. & Thomson, M. A. (1998). Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. Br Med J, 317: 465–468.
Bilous, M., McCredie, M. & Porter, L. (1995). Adequacy of histopathology reports for breast cancer in New South Wales. Pathology, 27: 306–311.
Bull, A. D., Biffin, A. H., Mella, J., Radcliffe, A. G., Stamatakis, J. D., Steele, R. J. & Williams, G. T. (1997). Colorectal cancer pathology reporting: a regional audit. J Clin Pathol, 50: 138–142.
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement 20: 37–46.
du Boulay, C. (1997). Continuing medical education for pathologists: an evaluation of the Royal College of Pathologists’ Wessex pilot scheme. J Clin Pathol, 50: 1022–1026.
Elston, C. W. & Ellis, I. O. (1991). Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology, 19: 403–410.
Hammond, E. H. & Flinner, R. L. (1997). Clinically relevant breast cancer reporting: using process measures to improve anatomic pathology reporting. Arch Pathol Lab Med, 121: 1171–1175.
Harvey, J. M., Sterrett, G. F., Parsons, R. W., Fitzgerald, C. J., Jamrozik, K., Dewar, J. M., Byrne, M. J., Ingram, D. M. & Sheiner, H. M. (1995). Breast cancer in Western Australia in 1989: IV. Summary of histopathological assessment in 655 cases. Pathology, 27: 12–17.
Henson, D. E., Ries, L., Freedman, L. S. & Carriaga, M. (1991). Relationship among outcome, stage of disease, and histologic grade for 22,616 cases of breast cancer. The basis for a prognostic index. Cancer, 68: 2142–2149.
Ma, M., Bell, J., Campbell, S., Basnett, I., Pollock, A. & Taylor, I. (1997). Breast cancer management: is volume related to quality? Clinical Advisory Panel. Br J Cancer, 75: 1652–1659.
Miller, J. M. & Slater, D. N. (1996). Do histopathology reports of primary cutaneous melanoma contain enough essential information? J Clin Pathol, 49: 202–204.
Nakhleh, R. E., Jones, B. & Zarbo, R. J. (1997). Mammographically directed breast biopsies: a College of American Pathologists Q-Probes study of clinical physician expectations and of specimen handling and reporting characteristics in 434 institutions. Arch Pathol Lab Med, 121: 11–18.
Rippey, J. J. (1996). Standardisation of histopathology reports. J Clin Pathol, 49: 864–865.
Shepherd, N. A. & Quirke, P. (1997). Colorectal cancer reporting: are we failing the patient? J Clin Pathol, 50: 266–267.
Wijetunga, L. H., Carmalt, H. L. & Gillett, D. J. (1996). A review of pathology reporting for breast cancer. Aust NZ J Surg, 66: 723–726.
Zarbo, R. J. (1992). Interinstitutional assessment of colorectal carcinoma surgical pathology report adequacy. A College of American Pathologists Q-Probes study of practice patterns from 532 laboratories and 15 940 reports. Arch Pathol Lab Med, 116: 1113–1119.
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Kricker, A., Armstrong, B., Smith, C. et al. An audit of breast cancer pathology reporting in Australia in 1995. Br J Cancer 80, 563–568 (1999). https://doi.org/10.1038/sj.bjc.6690392
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DOI: https://doi.org/10.1038/sj.bjc.6690392
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