Population-based method for investigating adherence to international recommendations for pathology reporting of primary cutaneous melanoma: Results of a EUROCARE-5 high resolution study

Association of Sentinel Node Biopsy and Pathological Report Completeness with Survival Benefit for Cutaneous Melanoma and Factors Influencing Their Different Uses in European Populations

Objectives: Standard care for cutaneous melanoma includes an accurate pathology report (PR) and sentinel lymph node biopsy (SLNB) for staging clinically node-negative >1 mm melanomas. We aimed to investigate the frequency of these indicators across European countries, also assessing consequences for survival. Methods: We analyzed 4245 melanoma cases diagnosed in six European countries in 2009−2013. Multivariable logistic regression was used to estimate the Odds Ratio (OR) of receiving complete PR with eight items or SLNB and model-based survival to estimate the five-year relative excess risks of death (RER). Results: Overall, 12% patients received a complete PR (range 2.3%, Estonia—20.1%, Italy); SLNB was performed for 68.8% of those with cN0cM0 stage (range 54.4%, Spain—81.7%, Portugal). The adjusted OR of receiving a complete PR was lower than the mean in Estonia (OR 0.11 (0.06−0.18)) and higher in Italy (OR 6.39 (4.90−8.34)) and Portugal (OR 1.39 (1.02−1.89)); it was higher for patients operated on in specialized than general hospitals (OR 1.42 (1.08−1.42)). In the multivariate models adjusted for age, sex, country and clinical-pathological characteristics, the RER resulted in being higher than the reference for patients not receiving a complete PR with eight items (RER 1.72 (1.08−2.72)), or for those not undergoing SLNB (RER 1.76 (1.26−2.47)) Patients with non-metastatic node-negative thickness >1 mm melanoma who did not undergo SLNB had a higher risk of death (RER (RER 1.69 (1.02−2.80)) than those who did. Conclusions: Accurate pathology profiling and SLNB carried survival benefit. Narrowing down between-countries differences in adhesion to guidelines might achieve better outcomes.

Importance of Complete Pathology Reporting for Neuroendocrine Carcinoma: WHO Guidelines Are a Good Start but Not Enough

BACKGROUND

Neuroendocrine carcinomas (NECs) are diagnosed through a combination of immunohistochemistry (IHC) and morphology according to WHO guidelines. The presence of these crucial components for classification in the pathology report is critical for appropriate understanding of the report especially since terminology and definitions of NEC have been changing a lot lately.

OBJECTIVES

The aim of this study is to assess the effect of WHO 2010 on the quality of pathology reporting for NEC and to assess the relevance of the criteria demanded.

METHODS

Patients registered with a NEC (gastrointestinal or unknown origin) in the Netherlands Cancer Registry (NCR) between 2008 and 2012 were included. Local pathology reports were reviewed for reporting of morphology and IHC comparing 2008-2010 (baseline) with 2011-2012. The diagnosis of NEC was confirmed according to WHO 2010, if synaptophysin or chromogranin were positive in a majority of cells and Ki-67 or mitotic count confirmed a grade 3 tumour.

RESULTS

591 patients were registered with a NEC in the NCR. 436 pathology reports were reviewed. 62.2% of reports described morphology, IHC and grading in accordance with WHO 2010. Reporting of these parameters increased from 50.0% in 2008 to 69.2% in 2012. Large-cell NEC could be confirmed in 45.0% of patients, increasing from 31.7% in 2008 to 56.7% in 2012 (p = 0.02). Other diagnoses included neuroendocrine tumour (NET) G1/2 13.3%, small-cell carcinoma 2.8%, no neuroendocrine neoplasm (NEN) 17.7%, NEN grade unknown 21.3%. Mean survival was 1.1 years in large cell NEC versus 2.2 years in NET G1/2 (p = 0.005).

CONCLUSION

Implementation of the WHO 2010 guideline is associated with a significant increase in reporting parameters needed for classification. Stratification of patients is more reliable based on reports containing all parameters. Guidelines alone however are not enough to warrant complete reporting; synoptic reports might be needed.

Synoptic reporting in Mohs micrographic surgery

There is currently no standardised reporting format for Mohs surgery with its operation reports mostly written in a narrative form making them prone to unintentional errors and omission of necessary data. Synoptic histology reporting is used to describe excised skin cancers such as melanomas and, more recently, squamous cell and basal cell carcinomas. Since Mohs surgery is utilised as the gold standard treatment for locally invasive squamous and basal cell carcinomas, we propose the use of our model of synoptic reporting to ensure the completeness and consistency of Mohs surgery operation reports.

Disparities in the management of cutaneous malignant melanoma. A population-based high-resolution study

Population-based cancer registry data from three Spanish areas were used to assess the patterns of care and adherence to guidelines for cutaneous malignant melanoma. We included 934 cases diagnosed in 2009-2013. Completeness of the pathology reports, imaging for detecting distant metastasis and the use of sentinel lymph node biopsy (SLNB) were analysed. The proportion of pathology reports that mentioned the essential pathological features required for T staging was 93%, ranging across geographic areas from 81% to 98% (p < 0.001). The percentage of low-risk patients who underwent no imaging studies, as proposed by guidelines, or only chest imaging ranged among areas from 0.6% to 84% (p < 0.001). Of the patients with clinically node-negative melanoma >1 mm thick and no distant metastases, 68% underwent SLNB, varying by area from 61% to 78% (p = 0.017). This study revealed wide geographic variation in different aspects of melanoma care. The use of a standardised structured pathology report could strengthen the completeness of reporting. Improvement strategies should also include efforts to reduce overuse of imaging in low-risk patients and to increase the adherence to guidelines recommendations on the use of SLNB.