Assessment of Gross Examination and Tissue Submission Practice in Hysterectomy Specimens with Leiomyomata
Luis Gai, Heather Currens, Robin Wirth, Reza Alaghehbandan, Sthepen Raab. Memorial University of Newfoundland, St. John's, NL, Canada
Background: Gross tissue examination and block submission protocols of common specimens, such as hysterectomy specimens for leiomyomata, are often not-standarized in actual practice. We assessed currently used gross descriptors and number of submitted blocks for hysterectomy specimens with leiomyomata to measure current variability in practice and to establish a standardized protocol in order to improve quality.
Design: We conducted a one-year retrospective study to assess the gross description and tissue block submission practices for 175 hysterectomy specimens for leiomyomata. Gross examinations were performed by 4 residents and 3 pathologists assistants. We reviewed pathology reports using a standardized checklist to assess 5 standard internal leiomyoa gross descriptors (eg. number, size, color, texture, and hemorrhage/necrosis), circumscription status, and number of blocks submitted of leiomyomata. We performed descriptive statistics including measures of central tendency and dispersion.
Results: We found that only 5% of the leiomyomata had the 5 standard descriptors, 11.4% had 4 descriptors, 22.8% had 3 descriptors, 42.8% had 2 descriptors, and 17.0% had 1 descriptor. Description of the circumscription status was present in only 10.2% of leiomyomata. In single leiomyoma specimens, 15.7% had 3-4 submitted blocks and 13.5% had more than 5 submitted blocks submitted. We found that the number of submitted blocks per leiomyoma increased as the size of leiomyoma increased; for a large leiomyoma (> 10 cm) the number of blocks ranged from 15-19, without worrisome changes in gross descriptors. One-third of specimens with a single leiomyoma had more than 5 blocks submitted.
Conclusions: We found a lack of standardization and high variability in the use of gross descriptors in the examination of leiomyomata, with the majority of leiomyomata poorly described. Over blocking occurred in large leiomyoma specimens and in one-third of small single leiomyoma specimens. We conclude that a more rigous adoption of standardized grossing protocols for specimens with leiomyomata would improve quality and decrease laboratory inefficiencies.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 254, Monday Afternoon