Assessing Quality of Pathology Reporting: The Case of Tongue Cancer

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Assessing Quality of Pathology Reporting The
Case of Tongue Cancer

• Lihua Liu1, PhD
• Wesley Y. Naritoku2, MD, PhD
• Juanjuan Zhang1, MS
• Lenard Berglund1, DMA
• Dennis Deapen1, DrPH
• Uttam K. Sinha3, MS, MD, FACS
• 1. Los Angeles Cancer Surveillance Program,
  Department of Preventive Medicine 2. Department
  of Pathology and Laboratory, LACUSC Medical
  Center 3. Dept. of Otolaryngology-Head and Neck
  Surgery of Keck School of Medicine, University
  of Southern California, Los Angeles, CA

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Background

• Pathological examinations and analyses provide
  crucial information for cancer treatment and
  patient care.
• In 2000, the College of American Pathologists
  (CAP) developed and published its 1st protocols
  to assist pathologists in providing clinically
  useful and relevant information.

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Background

• Little is known about the variations in pathology
  reporting
• A study of breast cancer has found most pathology
  reports lacked some of the key clinically
  relevant information
• Complete reporting of pathologic information is a
  shared responsibility
• Wilkinson et al. J Am Coll Surg 2003 19638-43.

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Study Objectives

• Evaluate completeness of information in pathology
  reports of tongue cancer, according to the CAP
  2000 protocol for upper aerodigestive tract
• Assess the effectiveness of CAP guidelines among
  practicing pathologists.

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Study Design

• Review of tongue cancer pathology reports of
  surgical specimen collected by the Los Angeles
  Cancer Surveillance Program (CSP)
• Assess the impact of CAP protocol by comparing
  review results of pathology reports of 2002-2003
  with those of 1997

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Evaluation Methods

• Each item on a pathology report is checked
  against the list of CAP identified key or
  recommended elements specific to the specimen
  type.
• Presence of each CAP identified key or
  recommended element scores 1 point and absence of
  the information scores 0 point.

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Evaluation Methods

• Adherence of a specific CAP key/recommended item
  is represented by the percentage of reports
  containing that item
• Completeness of reporting is indicated by the
  total score of a report

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Evaluation Details Clinical Info

• Patient Identification
• Responsible physician
• Procedure date
• Procedure
• Relevant history
• Relevant findings
• Clinical diagnosis
• Operative findings
• Anatomic sites of specimen

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Evaluation Details Macroscopic

• Specimen description
• Specimen size in 3-dimension
• Tumor size in 3-dimension
• Tumor site
• Margin description
• Anatomic structure involved
• Pattern of growth
• CAP identified key items

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Evaluation Details Microscopic

• Histologic type
• Histologic grade
• Extent of invasion (pT)
• Mode of invasion
• Depth of invasion
• Lymph nodes involvement (pN)
• Status of margin
• CAP identified key items

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Materials

• 2002-3 1997
• tongue cases 441 190
• reports reviewed 457 229
• resection reports 159 87
• w/ lymph nodes 97 49

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Results Clinical Info

• 2002-3 1997
• Pt. Identification 100 100
• Resp. Physician 99 82
• Procedure date 100 100
• Procedure 93 86
• Relevant history 28 34
• Relevant findings 1 0
• Clinical diagnosis 74 71
• Operative findings 0 0
• Sites of specimen 100 99

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Results Macroscopic

• 2002-3 1997
• Spec. description 92 86
• Spec. size in 3-D 96 93
• Tumor size in 3-D 33 34
• Tumor site 99 99
• Margin description 14 18
• Anat. structure invol. 68 70
• Pattern of growth 42 43
• CAP identified key items

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Results Microscopic

• 2002-3 1997
• Histologic type 100 100
• Histologic grade 85 91
• Extent of invasion (pT) 34 16
• Mode of invasion 23 16
• Depth of invasion 14 14
• LN involvement (pN) 43 29
• Status of margin 96 96
• CAP identified key items

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Depth of Invasion and Survival
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Results - Overall

• 2002-3 1997
• Clinical (9) 6.0 5.7
• Macroscopic (7) 4.4 4.4
• Microscopic (7) 3.8 3.5
• Key items (8) 5.7 (72) 5.4 (68)
• Total items (23) 14.2 (62) 13.7 (59)

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Conclusions

• Publication of CAP guidelines resulted in slight
  improvement in overall completeness of reporting
• Marked improvement was observed in the increased
  reporting of pT (extent of invasion, 34) and pN
  (LN involvement, 43)
• Overall completeness of reporting is 62 (72 for
  key items)

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Limitations

• The sample of pathology reports used in this
  study were collected by the CSP as a way of
  case-finding, may not include all types of
  reports (biopsy, resection, etc.) for each
  patient.
• The distribution of missing surgical pathology
  reports is assumed to be random.

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Implications

• To improve the quality of pathology reporting is
  an important task for better patient care
• Pathologists need the support from surgeons to
  provide necessary info, also do a better job in
  reporting all possible
• The CAP needs to adopt a more active role to
  enforce its protocols and monitor the quality of
  reporting among its members