Quality of Histopathological Reporting in Breast Cancer: Results From Four South African Breast Units
Journal – JCO Global Oncology
Article type – Journal research article – Clinical research
Publication date – Jan – 2021
Authors – Armand Toma, Daniel O’Neil , Maureen Joffe , Oluwatosin Ayeni,Carolina Nel , Eunice van den Berg , Simon Nayler, Herbert Cubasch , Boitumelo Phakathi , Ines Buccimazza, Sharon Čačala, Paul Ruff, Shane Norris , and Sarah Nietz
Keywords – Breast Cancer, Histopathology reporting, lymphovascular invasion
Open access – Yes
Speciality – General surgery, Surgical oncology
World region Southern Africa
Country: South Africa
Language – English
Submitted to the One Surgery Index on January 21, 2021 at 8:07 am
High-quality histopathology reporting forms the basis for treatment decisions. The quality indicator for pathology reports from the European Society of Breast Cancer Specialists was applied to a cohort from four South African breast units.
The study included 1,850 patients with invasive breast cancer and evaluated 1,850 core biopsies and 1,158 surgical specimen reports with cross-center comparisons. A core biopsy report required histologic type; tumor grade; and estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, with a confirmatory test for equivocal HER2 results. Ki-67 was regarded as optional. Pathologic stage, tumor size, lymphovascular invasion, and distance to nearest invasive margin were mandatory for surgical specimens. Specimen turnaround time (TAT) was added as a locally relevant indicator.
Seventy-five percent of core biopsy and 74.3% of surgical specimen reports were complete but showed large variability across study sites. The most common reason for an incomplete core biopsy report was missing tumor grade (17.9%). Half of the equivocal HER2 results lacked confirmatory testing (50.6%). Ki-67 was reported in 89.3%. For surgical specimens, the closest surgical margin was reported in 78.1% and lymphovascular invasion in 84.8% of patients. Mean TAT was 11.9 days (standard deviation [SD], 10.8 days) for core biopsies and 16.1 days (SD, 11.3) for surgical specimens.
Histopathology reporting is at a high level but can be improved, especially for tumor grade, HER2, and Ki-67, as is reporting of margins and lymphovascular invasion. A South African pathology consensus will reduce variability among laboratories. Routine use of standardized data sheets with synoptic reports and ongoing audits will improve completeness of reports over time.
OSI Number – 20889