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Percentage of all gastric resection reports containing statements on individual data items audited (all Wales)
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To audit the information content of pathology reports of oesophageal and gastric cancer resection specimens in Wales.
All such reports from the 16 NHS histopathology laboratories in Wales in a one year period were evaluated for their information content. Two standards were used: (1) best practice reporting, and (2) a minimum dataset required for in...
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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 bre...
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... In addition to oncologists, other clinical staff such as surgeons and general physicians may need to interpret cancer pathology reports; these reports should therefore be readily comprehensible. 7 According to the 7 th edition of the TNM Staging Classification for carcinoma of the stomach, at least 15 LNs must be surgically resected and evaluated by a pathologist. Unfortunately only two reports (3.5%) in our study had sufficient LNs. ...
... There were 14 gastric reports that were more than 75% complete, however no report was 100% complete. In a study in Wales by Burroughs et al. 7 specimen length, tumor type, depth of invasion, and presence or absence of LN involvement were recorded in the vast majority of cases (>95%). The minimum standards were attained in only 77% of gastric resections. ...
Background: Sentinel lymph node biopsy is used as an accurate staging procedure to detect early breast cancer. Several studies have documented that sentinel lymph node biopsy can accurately determine the status of axillary nodes. Sentinel node biopsy offers the advantage of accurately staging the axilla and eliminating the need for a full axillary dissection for patients who have a negative sentinel node. The aim of this study is to determine the predictors of non-sentinel lymph node metastasis by sentinel node biopsy.Methods: In this study, all patients (n=88) who underwent sentinel node biopsy for invasive breast cancer from June 2005 to June 2010 in Shahid Faghihi Hospital, Shiraz, Iran were enrolled. We reviewed the medical files of patients and their tumor characteristics. Statistical analysis was performed to determine whether any of thesecharacteristics alone could accurately predict the remaining non-sentinel node status. SPSS statistical package was used.Results: The mean age of the patients was 46.1 years. Tumor size was 2.73 cm. Of the 88 patients who underwent complete axillary node dissection, 34 had metastases in the non-sentinel nodes, with a mean of 4 positive non-sentinel nodes in each patient. Statistically, neither the patient’s age nor the clinicopathological features of the tumor were significantly associated with non-sentinel node metastases (all: P>0.05).Conclusion: Our study shows that neither the primary tumor characteristics nor the size of metastasis in the sentinel lymph node can predict the status of non-sentinel nodes. However, further investigation is necessary. Complete axillary node dissection shouldremain the most appropriate management for patients with positive sentinel lymph nodes.
... A similar 'best practice' report has been published by the Association of Clinical Pathologists (ACP) [26] and the College of American Pathologists has its own guidelines [27]. Despite this guidance the quality of pathological reporting has been variable [28,29]. Missing data items from an audit of oesophageal resection specimens reported in 2004 included key data (% missing) such as tumour differentiation (14%), proximal margin involvement (17%), distal margin involvement (19%), completeness of resection (48%) and circumferential margin involvement (48%) [29]. ...
... Missing data items from an audit of oesophageal resection specimens reported in 2004 included key data (% missing) such as tumour differentiation (14%), proximal margin involvement (17%), distal margin involvement (19%), completeness of resection (48%) and circumferential margin involvement (48%) [29]. It is hoped, as with other cancer types, that the increased use of proformas will increase quality and standardisation of specimen reporting [28] . The centralisation of oesophageal surgery services in one region resulted in a significant improvement in oesophageal resection specimen reporting [2]. ...
Adenocarcinoma of the oesophagus and gastro-oesophageal junction are rapidly increasing in incidence and have a well described sequence of carcinogenesis: the Barrett's metaplasia-dysplasia-adenocarcinoma sequence. During recent years there have been changes in the knowledge surrounding disease progression, cancer management and histopathology specimen reporting. Tumours around the gastro-oesophageal junction (GOJ) pose several specific challenges. Numerous difficulties arise when the existing TNM staging systems for gastric and oesophageal cancers are applied to GOJ tumours. The issues facing the current TNM staging and GOJ tumour classification systems are reviewed in this article. Recent evidence regarding the importance of several histopathologically derived prognostic factors, such as circumferential resection margin status and lymph node metastases, have implications for specimen reporting. With the rising use of multimodal treatments for oesophageal cancer it is important that the response of the tumour to this therapy is carefully documented pathologically. In addition, several controversial and novel areas such as endoscopic mucosal resection, lymph node micrometastases and the sentinel node concept are being studied. We aim to review these aspects, with special relevance to oesophageal and gastro-oesophageal cancer specimen reporting, to update the surgical oncologist with an interest in upper gastrointestinal cancer.
In spite of recent advances in the diagnosis and management of oesophageal cancer, the overall survival of the disease worldwide remains disappointingly low. In Greece and Cyprus, this may be partly due to a failure of health care providers to implement standardised treatment protocols in clinical practice. Development of clinical practice guidelines was undertaken as a joint project between the Hellenic Society of Medical Oncology (HeSMO) and Gastro-Intestinal Cancer Study Group (GIC-SG) in an effort to provide guidance for Greek and Cypriot clinicians in all aspects of the management of oesophageal cancer. A study group was formed comprising clinicians from different disciplines with a special interest in the management of oesophageal cancer. Following extensive review of the literature, the members of the group met in person and consensus statements were developed, which were later subjected to the Delphi survey process by invited national and international experts. Statements that achieved a rate of voting consensus > 80% were adopted. Those that reached a voting consensus of < 80% were revised or rejected. In total, 46 sentences were developed and subjected to the voting process. Of those, 45 sentences achieved a rate of consensus > 80% during the first voting round. One sentence that did not reach a satisfactory rate of consensus was revised by the members of the study group and subsequently incorporated to the final statement. Forty-six recommendations covering all aspects of the management of oesophageal cancer and concise treatment algorithms are proposed by the Hellenic and Cypriot Oesophageal Cancer Study Group. In particular, centralisation of services, care by multidisciplinary teams and adherence to clinical guidelines are strongly recommended.
Objective: To audit the completeness of histopathologic reports of Colorectal Cancer for prognostic information in a tertiary care hospital in the light of Royal College of Pathologists of UK guidelines. Material and Methods: Fifty-eitht histopathology reports of colorectal cancer from January 2007 to December 2012 were reviewed in Rehman Medical Institute, Peshawar, Pakistan for the information content in the light of Royal College of Pathologist of UK guidelines. Results: Majority of data items were mentioned in the histopathology reports, however background pathologic abnormalities, resections margins (Doughnuts), staging, apical lymph node involvement, relationship of tumor to peritoneal reflection and circumferential resection margins in rectal tumor were poorly mentioned. The mean lymph nodes isolated were twelve (12). Conclusion: The quality of histopathology reports is unsatisfactory. Action should be taken to improve the histopathologic reports by introducing structural proformas, clinicopathologic conferences and adequate guidelines.
Malignant epithelial tumoursBenign epithelial tumoursSecondary tumoursNon-epithelial tumoursTumour-like lesions
Complete and accurate histopathology reports are fundamental in providing quality cancer care. The Cancer Registry of Norway and the Norwegian Society of Pathology have previously developed a national electronic template for histopathology reporting on colorectal carcinoma resection specimens. The present study was undertaken to investigate (1) whether quality routines in Norwegian pathology laboratories might affect completeness of such histopathology reports and (2) whether the national electronic template improves completeness of histopathology reports compared with other modes of reporting. A questionnaire on quality routines was sent to the 21 pathology laboratories in Norway. All histopathology reports on colorectal cancer submitted to the Cancer Registry for a 3-month period in the autumn of 2007 were then evaluated on the mode of reporting and the presence of 11 key parameters. Of the 20 laboratories that handled resection specimens, 16 had written guidelines on histopathology reporting. Of these, 4 used the national electronic template, 5 used checklists, 3 used locally developed electronic templates, whereas the remaining 4 had neither obligatory checklists nor templates. Of the 650 histopathology reports submitted to the Cancer Registry in the 3-month period, the national template had been used in 170 cases (26.2%), checklists/locally developed templates in 112 cases (17.2%), and free text in 368 cases (56.6%). Quality routines in the pathology laboratories clearly governed reporting practice and the completeness of the histopathology reports. Use of the national electronic template significantly improved (P < .05) the presence of the 11 key parameters compared with reporting by checklists, locally developed electronic templates, or free text.
Quality-of-care indicators are measurable elements of practice performance that can assess the (change in) quality of the care provided. To date, the literature on quality-of-care indicators for oesophageal cancer surgery has not been reviewed.
We performed a review of the literature on quality-of-care indicators for oesophageal cancer surgery. The indicators were classified by their nature of care provision (structural, process, or outcome).
One hundred thirty articles were included. For structural measures, most evidence was found for the inverse relationship between hospital or surgeon volume and post-operative mortality. Few articles described the required infrastructural and organisational elements for oesophageal cancer surgery. Regarding process measures, the most common indicators were determinants of patient selection for surgery. Other process indicators with considerable evidence were found (e.g., multidisciplinary team management), though the number of studies was small. For outcome indicators, the level of evidence for pathological outcome measures was strong. Data on post-operative complications as outcome indicators varied widely.
Since there is considerable variation in the evaluation of quality of care, the uniform use of well-defined quality-of-care indicators to measure and document practice performance holds the promise of improving outcome in patients who undergo oesophageal cancer surgery.
To assess the clinical significance of circumferential resection margins according to current criteria of the College of American Pathologists (CAP) and the Royal College of Pathology (RCP) in esophageal and esophagogastric cancer.
Prospective study.
Single-surgeon database.
One hundred thirty-five patients (mean age, 64 years) with T3 tumors who underwent esophageal resection for cancer between 1991 and 2006. Main Outcome Measure Resection margins criteria and survival.
Three hundred seventy-four consecutive patients were prospectively identified from an institutional review board-approved database between 1991 and 2006. All patients with T3 tumors (n = 135) had their original pathologic slides reassessed by a single gastrointestinal pathologist. Operative mortality was 0.7% and mean follow-up was 3.1 years. Follow-up was complete in 81% of patients. Positive margins were identified in 16 cases in the CAP group vs 83 cases in the RCP group. Five-year Kaplan-Meier survival curves in the CAP group demonstrated a significant (P < .001) difference in survival, whereas the RCP group showed no difference (P = .20). In comparisons of negative vs positive margins, respectively, median survival in the CAP group (29.8 months [95% confidence interval (CI), 22.7-36.9] vs 8.33 months [95% CI, 4.4-12.3]) was significantly different from the RCP group (28.47 months [95% CI, 19.7-37.2] vs 22.23 months [95% CI, 13.6-30.8]). At 60-month follow-up, the positive predictive value with respect to survival was 100% in the CAP group vs 81% in the RCP group. Univariate and multivariate analyses identified R1 margins in the CAP group and lymph node ratio as being directly linked to survival.
Positive circumferential resection margins are prognostically important and the CAP criteria provide a more clinically meaningful assessment. Universal adoption of the CAP system can improve interpretation of international clinical trials and allow more accurate comparisons of outcomes.
