Quality of Reporting Gallbladder Carcinoma – An Audit of a Consultation Practice at a Tertiary Care Hepatopancreaticobiliary (HPB) Centre
Z Afshar-Ghotli, MA Khalifa, C Rowsell. Sunnybrook Health Sciences Centre, Toronto, Canada
Background: Over the past decade, much attention has been given to improving the quality of surgical pathology reports for cancer cases. In our jurisdiction, a successful pathology reporting project has focused on completeness through a Province-wide adoption of the College of American Pathologists (CAP) checklists. In five common disease sites, colorectal, breast, lung, prostate, and endometrial carcinoma specimens, the CAP synoptic reporting was mandated. Less common cancers, however, received less attention. The purpose of our study was to assess the completeness of reporting of gallbladder resection specimens in our referred-in cases as an example of reporting on a less common site.
Design: Consultation reports on gallbladder carcinomas were searched from the surgical pathology database at Sunnybrook Health Sciences Centre. Surgical pathology reports from the original hospitals were obtained, and evaluated for the presence of the following parameters as per the CAP Gallbladder Cancer protocol: Specimen type, Histologic type, Tumor site, Tumour Grade, Cystic duct margin, Liver bed margin, lymphovascular invasion, perineural invasion, pTNM staging. Our referral pool was community hospital-based laboratories who subscribed to the Province-wide pathology reporting project.
Results: Thirty-two cases of gallbladder carcinoma were received for consultation/review during the study period. Out of these cases, only one fulfilled CAP requirements for completeness. Missing required elements included: Tumor site (28/32, 87%); Tumor size (25/32, 77%); Histologic grade (6/32, 20%); Liver bed margin (23/32, 73%); Cystic duct margin (11/32, 33%). pTNM staging was not stated in 22/32 (70%) of reports. The non-mandatory elements of lymphovascular invasion and perineural invasion were missing in 22/32 (70%) and 23/32 (73%) of reports, respectively.
Conclusions: This audit provides a snapshot of completeness of gallbladder carcinoma reporting in our region. Some of the commonly missing elements (margins, stage) are critical to the multidisciplinary HPB team for treatment decisions. The results highlight the need for further educational initiatives on cancer reporting outside of the common organ sites which have already been targeted.
Category: Quality Assurance
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 246, Monday Morning