Assessing Quality of Pathology Reporting: The Case of Tongue Cancer Lihua Liu 1, PhD Wesley Y. Naritoku 2, MD, PhD Juanjuan Zhang 1, MS Lenard Berglund 1, DMA Dennis Deapen 1, DrPH Uttam K. Sinha 3, MS, MD, FACS 1. Los Angeles Cancer Surveillance Program, Department of Preventive Medicine; 2. Department of Pathology and Laboratory, LAC+USC Medical Center; 3. Dept. of Otolaryngology-Head and Neck Surgery; of Keck School of Medicine, University of Southern California, Los Angeles, CA

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 1 st protocols to assist pathologists in providing clinically useful and relevant information. 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; 196: Background

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. Study Objectives

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 with those of 1997 Study Design

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. 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 Evaluation Methods

1. 1. Patient Identification Responsible physician Procedure date Procedure Relevant history Relevant findings Clinical diagnosis Operative findings Anatomic sites of specimen Evaluation Details – Clinical Info

1. 1. 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 Evaluation Details – Macroscopic

1. 1. 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 Evaluation Details – Microscopic

# tongue cases # reports reviewed # resection reports # w/ lymph nodes Materials

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% Results – Clinical Info

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 Results – Macroscopic

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 Results – Microscopic

Depth of Invasion and Survival

Clinical (9) Macroscopic (7) Microscopic (7) Key items (8) 5.7 (72%) 5.4 (68%) Total items (23)14.2 (62%) 13.7 (59%) Results - Overall

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) Conclusions

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. Limitations

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 Implications