[2114] In Pursuit of Comprehensive Pathology Reports: Implementing Electronic Cancer Checklists

Lauren N Stuart, Annie H Simpson, Alexis B Carter, Kyle T Bradley. Emory University, Atlanta, GA

Background: Cancer pathology reports must include all required elements listed in the College of American Pathologists (CAP) Cancer Protocols according to Standard 4.6 of the American College of Surgeons Commission on Cancer, the CAP laboratory accreditation program, and many state cancer registries. Our institution recently implemented a new Anatomic Pathology information system, which enabled data entry into electronic Cancer Checklists (eCCs) including associated algorithms for completeness and accuracy. The previous system relied on free text templates (“Manual” method).
Design: Consecutive pathology reports for breast, kidney, prostate, lung, and colon cancer that included a synoptic report based on the 2009 CAP Protocols were reviewed. Signed reports using “Manual” and eCC methods were compared for 1) percentage of cases containing all required elements, and 2) number and type of missing required elements. If data elements were not applicable to the specimen they were not counted in the total.
Results: 758 “Manual” and 341 eCC reports were analyzed (see Table for results). The most common missing elements in “Manual” reports were margins/distance to margin (92 breast, 20 lung, 6 colon), presence/absence of lobular carcinoma in situ (57 breast), ancillary studies (39 breast), and evaluation of non-neoplastic kidney (19 kidney). Only four eCC reports had a missing element: distance to margin (3 lung) and ancillary studies (1 breast).

	No. of Cases Reviewed		Cases Containing All Required Elements, No. (% of Total)		No. of Cases Missing 1, 2, 3, ≥4 Required Elements
	"Manual"	eCC	"Manual"	eCC	"Manual"	eCC
Breast	341	126	176 (51.6)	125 (99.2)	104, 52, 7, 2	1, 0, 0, 0
Kidney	131	64	105 (80.2)	64 (100.0)	24, 1, 1, 0	0, 0, 0, 0
Prostate	121	39	107 (88.4)	39 (100.0)	14, 0, 0, 0	0, 0, 0, 0
Lung	98	68	78 (79.6)	65 (95.6)	18, 2, 0, 0	3, 0, 0, 0
Colon	67	44	54 (80.6)	44 (100.0)	6, 3, 2, 2	0, 0, 0, 0
Total	758	341	520 (68.6)	337 (98.8)

Conclusions: Switching to eCCs dramatically improved the percentage of cancer reports containing all required elements (from 68.6% to 98.8%). For certain required elements in “Manual” reports, it was often not clear if the element was missing due to an oversight or because it was not applicable to the specimen. The consistent use of “absent” or “N/A” in eCC reports for such elements eliminated this ambiguity. Overall, laboratories using manual methods should consider changing to eCCs in order to increase compliance with cancer reporting requirements.
Category: Quality Assurance

Monday, March 19, 2012 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 305, Monday Morning