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Ivanova M, Porta FM, D'Ercole M, Pescia C, Sajjadi E, Cursano G, De Camilli E, Pala O, Mazzarol G, Venetis K, Guerini-Rocco E, Curigliano G, Viale G, Fusco N. Standardized pathology report for HER2 testing in compliance with 2023 ASCO/CAP updates and 2023 ESMO consensus statements on HER2-low breast cancer. Virchows Arch 2024; 484:3-14. [PMID: 37770765 DOI: 10.1007/s00428-023-03656-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
Since the release of the DESTINY-Breast04 (DB-04) trial findings in June 2022, the field of pathology has seen a renaissance of HER2 as a predictive biomarker in breast cancer. The trial focused on patients with metastatic breast cancer who were classified as "HER2-low," i.e., those with immunohistochemistry (IHC) HER2 1 + or 2 + and negative in situ hybridization (ISH) results. The study revealed that treating these patients with trastuzumab deruxtecan (T-DXd) instead of the oncologist's chosen chemotherapy led to outstanding improvements in survival. This has challenged the existing binary HER2 pathological classification system, which categorized tumors as either positive (overexpression/amplification) or negative, as per the ASCO/CAP 2018 guideline reaffirmed by ASCO/CAP 2023 guideline update. Given that DB-04 excluded patients with HER2 IHC score 0 status, the results of the ongoing DB-06 trial may shed further light on the potential benefits of T-DXd therapy for these patients. Roughly half of all breast cancers are estimated to belong to the HER2-low category, which does not represent a distinct or specific subtype of cancer. Instead, it encompasses a diverse group of tumors that exhibit clinical, morphological, immunohistochemical, and molecular variations. However, HER2-low offers a distinctive biomarker status that identifies a specific therapeutic regimen (i.e., T-DXd) linked to a favorable prognosis in breast cancer. This unique association emphasizes the importance of accurately identifying these tumors. Differentiating between a HER2 IHC score 0 and score 1 + has not been clinically significant until now. To ensure accurate classification and avoid misdiagnosis, it is necessary to adopt standardized procedures, guidelines, and specialized training for pathologists in interpreting HER2 expression in the lower spectrum. Additionally, the utilization of artificial intelligence holds promise in supporting this endeavor. Here, we address the current state of the art and unresolved issues in assessing HER2-low status, with a particular emphasis on the score 0. We explore the dilemma surrounding the exclusion of HER2-zero patients from potentially beneficial therapy based on traditional HER2 testing. Additionally, we examine the clinical context, considering that DB-04 primarily involved heavily pretreated late-stage metastatic breast cancers. We also delve into emerging evidence suggesting that extrapolating HER2-low status from the original diagnosis may lead to misleading results. Finally, we provide recommendations for conducting high-quality testing and propose a standardized pathology report in compliance with 2023 ASCO/CAP updates and 2023 ESMO consensus statements on HER2-low breast cancer.
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Affiliation(s)
- Mariia Ivanova
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Francesca Maria Porta
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Marianna D'Ercole
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Carlo Pescia
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elham Sajjadi
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Giulia Cursano
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Oriana Pala
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giovanni Mazzarol
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
- Division of New Drugs and Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy.
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Ly A, Balassanian R, Alperstein S, Donnelly A, McGrath C, Sohani AR, Stelow EB, Thrall MJ, Zhang ML, Pitman MB. One procedure-one report: the Re-Imagine Cytopathology Task Force position paper on small tissue biopsy triage in anatomic pathology. J Am Soc Cytopathol 2023; 12:395-406. [PMID: 37270328 DOI: 10.1016/j.jasc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Endoscopic biopsy procedures increasingly generate multiple tissue samples from multiple sites, and frequently retrieve concurrent cytologic specimens and small core needle biopsies. There is currently lack of consensus in subspecialized practices as to whether cytopathologists or surgical pathologists should review such samples, and whether the pathology findings should be reported together or separately. MATERIALS AND METHODS In December 2021, the American Society of Cytopathology convened the Re-Imagine Cytopathology Task Force to examine various workflows that would facilitate unified pathology reporting of concurrently obtained biopsies and improve clinical care. RESULTS AND CONCLUSIONS This position paper summarizes the key points and highlights the advantages, challenges, and resources available to support the implementation of such workflows that result in "one procedure-one report".
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Affiliation(s)
- Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Susan Alperstein
- Department of Pathology, Weill Cornell Medical College, New York, New York
| | - Amber Donnelly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cindy McGrath
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward B Stelow
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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Taraz Jamshidi S, Gharib M, Etemadi M, Jarahi L, Hosseini S, Ariamanesh M, Dehghani M. Pathology Reports: Discrepancy Patterns of Second Opinions in a Referral Cancer Center. Cancer Invest 2023; 41:1-8. [PMID: 36601856 DOI: 10.1080/07357907.2022.2162072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/08/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the diagnostic mismatch (discrepancy) of pathology reports in consulted specimens referred for second opinion. MATERIALS AND METHODS This cross-sectional study was conducted at a major cancer center, Omid Hospital. In this study, 350 primary pathology reports and 350 reviewed pathology reports were extracted from the archives of Omid Hospital from 2011 to 2020 and assessed in terms of the extent of discrepancy, by two pathologists and one oncologist. The required data for each sample were entered into a checklist and then statistically analyzed. Cases with the same diagnosis on both reports were assigned to the matched group and the rest were assigned to the minor or major mismatch (discrepancy) group. Minor mismatches included changes in diagnosis that did not lead to changes in treatment (may lead to changes in prognosis or provide additional information to the oncologist) and major mismatches included changes in diagnosis leading to changes in treatment or remedies. RESULTS Two hundred seven cases (59.1%) out of three hundred fifty cases had concordant results between the diagnosis of the first pathologist and the reviewing pathologist. In one hundred forty-three cases (40.9%) mismatch (discrepancy) was observed, including eighty- two cases (23.4%) with minor mismatches (discrepancy) and sixty-one cases (17.4%) with major mismatches (discrepancy). In the major mismatch group, fifteen cases (4.3%) changed from malignant to benign, eighteen cases (5.1%) changed from benign to malignant, two cases (0.6%) changed from one stage to another stage of Disease and twenty-six cases (7.4%) had changes in the type of malignancy. In this study, it was found that there was no significant relationship between anatomical areas of sampling and diagnostic mismatch (p = 0.254). The study also found that the rate of diagnostic mismatch in specimens obtained by resection or excisional biopsy was greater than that of small biopsies (eighty cases (22.8%) and sixty-two cases (17.7%, respectively)). There was no significant relationship in this regard (p = 0.077). CONCLUSION Compared to most similar studies, the present study reported the highest discrepancy between the diagnosis of the first pathologist and the reviewing pathologist (40.9%).
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Affiliation(s)
- Shirin Taraz Jamshidi
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Gharib
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Etemadi
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Ariamanesh
- Department of Pathology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Mansoureh Dehghani
- Radiation Oncologist, Mashhad University of Medical Sciences, Mashhad, Iran
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Park YS, Kook MC, Kim BH, Lee HS, Kang DW, Gu MJ, Shin OR, Choi Y, Lee W, Kim H, Song IH, Kim KM, Kim HS, Kang G, Park DY, Jin SY, Kim JM, Choi YJ, Chang HK, Ahn S, Chang MS, Han SH, Kwak Y, Seo AN, Lee SH, Cho MY. A Standardized Pathology Report for Gastric Cancer: 2nd Edition. J Gastric Cancer 2023; 23:107-145. [PMID: 36750994 PMCID: PMC9911618 DOI: 10.5230/jgc.2023.23.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023] Open
Abstract
The first edition of 'A Standardized Pathology Report for Gastric Cancer' was initiated by the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists and published 17 years ago. Since then, significant advances have been made in the pathologic diagnosis, molecular genetics, and management of gastric cancer (GC). To reflect those changes, a committee for publishing a second edition of the report was formed within the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. This second edition consists of two parts: standard data elements and conditional data elements. The standard data elements contain the basic pathologic findings and items necessary to predict the prognosis of GC patients, and they are adequate for routine surgical pathology service. Other diagnostic and prognostic factors relevant to adjuvant therapy, including molecular biomarkers, are classified as conditional data elements to allow each pathologist to selectively choose items appropriate to the environment in their institution. We trust that the standardized pathology report will be helpful for GC diagnosis and facilitate large-scale multidisciplinary collaborative studies.
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Affiliation(s)
- Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Baek-hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Mi-Jin Gu
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ok Ran Shin
- Department of Hospital Pathology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Younghee Choi
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Wonae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Guhyun Kang
- LabGenomics Clinical Laboratories, Seongnam, Korea
| | | | - So-Young Jin
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Yoon Jung Choi
- Department of Pathology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hee Kyung Chang
- Department of Pathology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Soomin Ahn
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Song-Hee Han
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Mee-Yon Cho
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Park YS, Kook MC, Kim BH, Lee HS, Kang DW, Gu MJ, Shin OR, Choi Y, Lee W, Kim H, Song IH, Kim KM, Kim HS, Kang G, Park DY, Jin SY, Kim JM, Choi YJ, Chang HK, Ahn S, Chang MS, Han SH, Kwak Y, Seo AN, Lee SH, Cho MY. A standardized pathology report for gastric cancer: 2nd edition. J Pathol Transl Med 2023; 57:1-27. [PMID: 36647283 PMCID: PMC9846007 DOI: 10.4132/jptm.2022.12.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
The first edition of 'A Standardized Pathology Report for Gastric Cancer' was initiated by the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists and published 17 years ago. Since then, significant advances have been made in the pathologic diagnosis, molecular genetics, and management of gastric cancer (GC). To reflect those changes, a committee for publishing a second edition of the report was formed within the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. This second edition consists of two parts: standard data elements and conditional data elements. The standard data elements contain the basic pathologic findings and items necessary to predict the prognosis of GC patients, and they are adequate for routine surgical pathology service. Other diagnostic and prognostic factors relevant to adjuvant therapy, including molecular biomarkers, are classified as conditional data elements to allow each pathologist to selectively choose items appropriate to the environment in their institution. We trust that the standardized pathology report will be helpful for GC diagnosis and facilitate large-scale multidisciplinary collaborative studies.
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Affiliation(s)
- Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Baek-hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea
| | - Mi-Jin Gu
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ok Ran Shin
- Department of Hospital Pathology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Younghee Choi
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Wonae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Guhyun Kang
- LabGenomics Clinical Laboratories, Seongnam, Korea
| | | | - So-Young Jin
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Yoon Jung Choi
- Department of Pathology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hee Kyung Chang
- Department of Pathology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Soomin Ahn
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Song-Hee Han
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Corresponding Author: Sung Hak Lee, MD, PhD, Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-1617, Fax: +82-2-2258-1627, E-mail:
| | - Mee-Yon Cho
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea,Corresponding Author: Mee-Yon Cho, MD, PhD, Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: +82-33-741-1553, Fax: +82-33-731-6590, E-mail:
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Rodríguez J, Santana Á, Herráez P, Killick DR, de Los Monteros AE. Epidemiology of canine mammary tumours on the Canary Archipelago in Spain. BMC Vet Res 2022; 18:268. [PMID: 35821034 PMCID: PMC9277912 DOI: 10.1186/s12917-022-03363-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mammary gland tumours are the most frequently diagnosed tumours in the female dogs but just a few studies have analysed their epidemiology. Therefore, we set out to describe the epidemiology of canine mammary cancer in the Canary Archipelago, Spain. We analysed a pathology tumour registry (PTR) and identified 7362 samples obtained from 5240 female dogs resident on the Canary Archipelago during an 18-year period (2003-2020). Using a case-control study design, we compared mammary tumour affected dogs with the Canarian canine population registry in order to elucidate the breed associations for these tumours. RESULTS The frequency of a diagnosis of mammary tumours relative to all tumour diagnoses in female dogs decreased during the study period from 62.7% to 48.9%. Contemporaneously, the proportion of dogs diagnosed with mammary tumours who were also neutered increased from 13.6% to 26.9%. There was a negative correlation (R = -0.84) between these changes. Additional findings were that: the proportion of female dogs diagnosed with multiple tumours increased by 23.5% and that the proportion of malignant tumours 89.2% diagnosed has remained stable through the period. Benign mammary tumours were diagnosed at younger ages (9.2 years old) than carcinomas (9.7 years old) and sarcomas (10.4 years old). Epithelial mammary tumours were diagnosed at younger ages in entire female dogs. Samoyed, Schnauzer, Poodle, German Pinscher and Cocker Spaniel were the breeds with the highest odds-ratios (OR) in comparison with the reference (crossbreeds) while Miniature Pinscher, American Staffordshire Terrier, English Pointer as well as some local breeds such as the Canary Warren Hound and the Majorero had the lowest ORs. CONCLUSIONS This study provides a description of the changing epidemiology of canine mammary cancer in the Canary Archipelago over the last two decades. We found high rates of CMT with a significant predominance of malignant tumours. Exact risk factors are uncertain, but a combination of environmental, regional socioeconomic affecting human and their pets, and animal management factors are likely to play a part. Specifically, neutering was negatively associated with the proportion of epithelial mammary gland tumours and breeds native to the region were at lower risk of mammary tumours. A deeper analysis of all these factors will facilitate a deeper understanding of the epidemiology of mammary gland tumours in both the canine and the human population.
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Affiliation(s)
- José Rodríguez
- Institute for Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas, Canary Archipelago, Spain.
| | - Ángelo Santana
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas, Canary Archipelago, Spain
| | - Pedro Herráez
- Institute for Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas, Canary Archipelago, Spain
| | - David R Killick
- Institute of Infection, Veterinary Science and Ecology, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
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Abstract
OBJECTIVES The pathology report serves as a crucial communication tool among a number of stakeholders. It can sometimes be challenging to understand. A communication barrier exists among pathologists, other clinicians, and patients when interpreting the pathology report, leaving both clinicians and patients less empowered when making treatment decisions. Miscommunication can lead to delays in treatment or other costly medical interventions. METHODS In this review, we highlight miscommunication in pathology reporting and provide potential solutions to improve communication. RESULTS Up to one-third of clinicians do not always understand pathology reports. Several causes of report misinterpretation include the use of pathology-specific jargon, different versions of staging or grading systems, and expressions indicative of uncertainty in the pathologist's report. Active communication has proven to be crucial between the clinician and the pathologist to clarify different aspects of the pathology report. Direct communication between pathologists and patients is evolving, with promising success in proof-of-principle studies. Special attention needs to be paid to avoiding inaccuracy while trying to simplify the pathology report. CONCLUSIONS There is a need for active and adequate communication among pathologists, other clinicians, and patients. Clarity and consistency in reporting, quantifying the level of confidence in diagnosis, and avoiding misnomers are key steps toward improving communications.
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Affiliation(s)
- Lorna Mirham
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine, North York General Hospital, Toronto, Canada
| | - Jessica Hanna
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - George M Yousef
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto, Canada
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Miettinen J, Tanskanen T, Degerlund H, Nevala A, Malila N, Pitkäniemi J. Accurate pattern-based extraction of complex Gleason score expressions from pathology reports. J Biomed Inform 2021; 120:103850. [PMID: 34182148 DOI: 10.1016/j.jbi.2021.103850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 04/25/2021] [Accepted: 06/19/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The Gleason score is an important grading factor of prostate cancer. Gleason scores can be extracted from pathology report texts using regular expressions, but previously developed programmes have targeted only relatively simple Gleason score expressions. We developed a programme capable of extracting also complex expressions. The programme is relatively easy to adapt to other languages and datasets. METHODS We developed and evaluated our regular expression-based programme using manually processed pathology reports of prostate cancer cases diagnosed in Finland in 2016-2017. Both simple and complex Gleason score expressions were targeted. We measured the performance of our programme using recall, precision, and the F1. The proportion of complex Gleason score expressions was estimated as the complement of the recall when only addition expressions (e.g. "Gleason 3 + 4") were targeted. RESULTS The detection of values (scores and score components) is based on mandatory keywords before or after the value. The programme favours precision over recall by primarily allowing for lists of optional expressions between keyword-value pairs and only secondarily allowing for arbitrary expressions. The programme is straightforward to adapt to new datasets by modifying the lists of mandatory and optional expressions. The full and addition-only programmes had 92% (95% CI: [90%, 95%]) and 65% ([61%, 70%]) recall and high precision (98% [97%, 99%] and 100% [99%, 100%]), respectively. The estimated proportion of complex Gleason score expressions was 100-65 = 35%. CONCLUSIONS Even complex Gleason score expressions can be extracted with high recall and precision using regular expressions. We recommend implementing automated Gleason score extraction where possible by adapting our validated programme.
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Cho SY, Park SY, Bae YK, Kim JY, Kim EK, Kim WG, Kwon Y, Lee A, Lee HJ, Lee JS, Park JY, Gong G, Yoon HK. Standardized pathology report for breast cancer. J Pathol Transl Med 2021; 55:1-15. [PMID: 33461287 PMCID: PMC7829577 DOI: 10.4132/jptm.2020.11.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/21/2022] Open
Abstract
Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of 'standard data elements,' 'conditional data elements,' and a biomarker report form. The 'standard data elements' consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the 'conditional data elements.' In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.
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Affiliation(s)
- Soo Youn Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jee Yeon Kim
- Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji University College of Medicine, Seoul, Korea
| | - Woo Gyeong Kim
- Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Youngmee Kwon
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Ahwon Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Jin Lee
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Jee Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Busan Paik Hospital, Inje University, Busan, Korea
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10
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Fevrier HB, Liu L, Herrinton LJ, Li D. A Transparent and Adaptable Method to Extract Colonoscopy and Pathology Data Using Natural Language Processing. J Med Syst 2020; 44:151. [PMID: 32737597 DOI: 10.1007/s10916-020-01604-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
Key variables recorded as text in colonoscopy and pathology reports have been extracted using natural language processing (NLP) tools that were not easily adaptable to new settings. We aimed to develop a reliable NLP tool with broad adaptability. During 1996-2016, Kaiser Permanente Northern California performed 401,566 colonoscopies with linked pathology. We randomly sampled 1000 linked reports into a Training Set and developed an NLP tool using SAS® PERL regular expressions. The NLP tool captured five colonoscopy and pathology variables: type, size, and location of polyps; extent of procedure; and quality of bowel preparation. We used a Validation Set (N = 3000) to confirm the variables' classifications using manual chart review as the reference. Performance of the NLP tool was assessed using the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's κ. Cohen's κ ranged from 93 to 99%. The sensitivity and specificity ranged from 95 to 100% across all categories. For categories with prevalence exceeding 10%, the PPV ranged from 97% to 100% except for adequate quality of preparation (prevalence 92%), for which the PPV was 65%. For categories with prevalence below 10%, the PPVs ranged from 62% to 100%. NPVs ranged from 94% to 100% except for the "complete" extent of procedure, for which the NPV was 73%. Using information from a large community-based population, we developed a transparent and adaptable NLP tool for extracting five colonoscopy and pathology variables. The tool can be readily tested in other healthcare settings.
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11
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Ghoreishi S, Zargaran M, Baghaei F. Survey of pathology reports with no definitive diagnosis in oral lesions: the necessary skills for the clinicians. Heliyon 2020; 6:e03848. [PMID: 32368657 PMCID: PMC7184257 DOI: 10.1016/j.heliyon.2020.e03848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/22/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Biopsy plays a crucial role in definitive diagnosis of lesions and consequently, appropriate treatment of them. Clinicians should correctly do the biopsy in accordance to the existing principles and guidelines to prevent adverse effects on the pathologist's diagnosis. This study aimed to determine the frequency and reasons for not providing definitive histopathological diagnosis of the biopsy samples belong to the laboratory of the Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Hamadan University of Medical Sciences. Methods Archival reports belong to 2006–2016 period of the related laboratory were studied to determine the reports with no definitive histopathological diagnosis. Results Out of 1018 archived reports; 90 reports (8.84%) had no definitive diagnosis. The most common reasons found were incompatibility between the clinical/radiographical diagnosis and histopathological findings for 42 cases (46.66%), absence of adequate information about the clinical/radiographical findings for 17 cases (18.88%) and inappropriate quality of samples for 13 cases (14.44%), respectively. Conclusion The reasons for not providing definitive histopathological diagnosis of the biopsy samples in present study indicated that preparation, assessment and diagnosis of microscopic slide by pathologists do not separate from the clinician performance.
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Affiliation(s)
- Soroush Ghoreishi
- Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Massoumeh Zargaran
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Fahimeh Baghaei
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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12
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Kim BH, Kim JM, Kang GH, Chang HJ, Kang DW, Kim JH, Bae JM, Seo AN, Park HS, Kang YK, Lee KH, Cho MY, Do IG, Lee HS, Chang HK, Park DY, Kang HJ, Sohn JH, Chang MS, Jung ES, Jin SY, Yu E, Han HS, Kim YW. Standardized Pathology Report for Colorectal Cancer, 2nd Edition. J Pathol Transl Med 2019; 54:1-19. [PMID: 31722452 PMCID: PMC6986966 DOI: 10.4132/jptm.2019.09.28] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
The first edition of the 'Standardized Pathology Report for Colorectal Cancer,' which was developed by the Gastrointestinal Pathology Study Group (GIP) of the Korean Society of Pathologists, was published 13 years ago. Meanwhile, there have been many changes in the pathologic diagnosis of colorectal cancer (CRC), pathologic findings included in the pathology report, and immunohistochemical and molecular pathology required for the diagnosis and treatment of colorectal cancer. In order to reflect these changes, we (GIP) decided to make the second edition of the report. The purpose of this standardized pathology report is to provide a practical protocol for Korean pathologists, which could help diagnose and treat CRC patients. This report consists of "standard data elements" and "conditional data elements." Basic pathologic findings and parts necessary for prognostication of CRC patients are classified as "standard data elements," while other prognostic factors and factors related to adjuvant therapy are classified as "conditional data elements" so that each institution could select the contents according to the characteristics of the institution. The Korean version is also provided separately so that Korean pathologists can easily understand and use this report. We hope that this report will be helpful in the daily practice of CRC diagnosis.
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Affiliation(s)
- Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Gyeong Hoon Kang
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jin Chang
- Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dong Wook Kang
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jung Ho Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Sung Park
- Department of Pathology, Chonbuk National University Medical School, Jeonju, Korea
| | - Yun Kyung Kang
- Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Mee Yon Cho
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - In-Gu Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Chang
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyo Jeong Kang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang UniversityCollege of Medicine, Seoul, Korea
| | - Eunsil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Youn Wha Kim
- Department of Pathology, Kyung Hee University College of Medicine, Seoul, Korea
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13
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Roos E, Franken LC, Soer EC, van Hooft JE, Takkenberg RB, Klümpen HJ, Wilmink JW, van de Vijver MJ, van Gulik TM, Verheij J. Lost in translation: confusion on resection and dissection planes hampers the interpretation of pathology reports for perihilar cholangiocarcinoma. Virchows Arch 2019; 475:435-43. [PMID: 31446465 DOI: 10.1007/s00428-019-02621-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/04/2019] [Accepted: 07/11/2019] [Indexed: 01/03/2023]
Abstract
In perihilar cholangiocarcinoma (PHC), interpretation of the resection specimen is challenging for pathologists and clinicians alike. Thorough and correct reporting is necessary for reliable interpretation of residual disease status. The aim of this study is to assess completeness of PHC pathology reports in a single center and assess what hampers interpretation of pathology reports by clinicians. Pathology reports of patients resected for PHC at a single expert tertiary center drafted between 2000 and 2018 were assessed. Reports were assessed regarding completeness, according to the guideline of the International Collaboration on Cancer Reporting (ICCR). A total of 146 reports were assessed. Prognostic tumor characteristics such as vasoinvasive growth and perineural growth were missing in 30/146 (34%) and 22/146 (15%), respectively. One or more planes were missing in 94/146 (64%) of the reports, with the periductal dissection plane missing in 51/145 (35%). Residual disease could be re-classified from R0 to R1 in 22 patients (15%). Reasons for R1 in these patients were the presence of a positive periductal dissection plane (n = 2), < 1-mm margin at the periductal dissection plane (n = 11), or liver parenchyma (n = 9). Completeness of reports improved significantly when drafted by an expert HPB pathologist. This study demonstrates that pathology reporting of PHC is challenging. Reports are frequently incomplete and often do not incorporate assessment of all resection planes and the dissection plane. The periductal dissection plane is frequently overlooked, but is a major cause of residual disease.
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14
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Baranov NS, Nagtegaal ID, van Grieken NCT, Verhoeven RHA, Voorham QJM, Rosman C, van der Post RS. Synoptic reporting increases quality of upper gastrointestinal cancer pathology reports. Virchows Arch 2019; 475:255-9. [PMID: 31144018 DOI: 10.1007/s00428-019-02586-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 11/12/2022]
Abstract
Introduction Traditionally, surgical pathology reports are narrative. These report types are prone to error and missing data; therefore, structured standardized reporting was introduced. However, the effect of synoptic reporting on the completeness of esophageal and gastric carcinoma pathology reports is not yet established. Materials and methods A population-based retrospective nationwide cohort study in the Netherlands was conducted over a period of 2012–2016, utilizing the Netherlands Cancer Registry for patient data and the nationwide network and registry of histology for pathology data. Results In total, 1148 narrative and 1311 synoptic pathology reports were included. Completeness was achieved in 56.4% of the narrative reports versus 97.0% of the synoptic reports (p < 0.01). Out of 21 standard items, 15 were significantly more frequently reported in synoptic reports. Conclusion Synoptic reporting improves surgical pathology reporting quality and should be implemented in standard patient care. Electronic supplementary material The online version of this article (10.1007/s00428-019-02586-w) contains supplementary material, which is available to authorized users.
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15
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Boutanos C, Capdepont M, Svrcek M, Thélu F, Guedj N, Poizat F, Bibeau F, Turlin B, Rousseau A, Bardier A, Selves J, Desrousseaux M, Le Pessot F, Bonhomme B, Laverrière MH, Julié C, Eyremandi RP, Stanislas S, Bazille C, Daubech A, Lazure T, Bordier MS, Demoures A, Rullier A. National multicentric evaluation of quality of pathology reports for rectal cancer in France in 2016. Virchows Arch 2019; 474:561-8. [PMID: 30729335 DOI: 10.1007/s00428-019-02534-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/07/2019] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
The quality of pathologic assessment of rectal cancer specimens is crucial for treatment efficiency and survival. The Royal College of Pathologists (RCP) recommends evaluating the quality of the pathology report in routine practice using three quality indicators (QIs): the number of lymph nodes (LNs) analyzed (≥ 12), the rate of venous invasion (VI ≥ 30%), and peritoneal involvement (pT4a ≥ 10%). In this study, we evaluated the three QIs of the French national pathology reports and compared them with British guidelines and assessed the influence of neoadjuvant radiochemotherapy on QIs. From January 1 to December 31, 2016, all pathology reports for rectal adenocarcinoma were collected from French departments. Neoadjuvant radiochemotherapy included long-course radiotherapy with concomitant 5-FU-based chemotherapy. A total of 983 rectal cancer pathology reports were evaluated. A median of 15 LNs were analyzed and 81% of centers had ≥ 12 LNs. The rate of VI was 30% and 41% of centers had ≥ 30% VI. The rate of pT4a was 4% and 18% of centers reported ≥ 10% pT4a. None of the centers reached the threshold for the three QIs. All three QIs were lower after radiochemotherapy compared to surgery alone. In conclusion, in French routine practice, the values of two of the three QIs (LNs analyzed and VI) were globally in line with RCP guidelines. However, the rate of pT4a was very low, particularly after radiochemotherapy, suggesting its low value in rectal cancer.
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16
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Spajić B, Nikles S, Grubišić I, Knežević M, Shoipi S, Ulamec M, Štimac G, Tomašković I, Ružić B. Histopathological Outcomes after Radical Prostatectomy for Prostate Cancer Based On a New Grading System. Acta Clin Croat 2018; 57:50-55. [PMID: 30457248 DOI: 10.20471/acc.2018.57.s1.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
One of the main reasons for the introduction of a new grading system was Gleason sum 7, which differed significantly in the prognosis of the disease depending on the primary Gleason. The aim of this study was to compare grade group 2 and grade group 3, and the impact of cancer percentages in final pathology reports after radical prostatectomy on the occurrence of T3 stage of the disease after radical prostatectomy of clinically localized prostate cancer. The study covered 365 patients with clinically localized prostate cancer who underwent radical retropubic prostatectomy (RRP) over the period of two years. The average percentage of carcinomas found in pathology reports after RRP was 20.1%. With the increase in the grade group, the average percentage of carcinomas in pathology reports increased significantly, p <0.001. With regard to grade groups 2 and 3, irrespective of cancer percentages in pathology reports, more cases of T3 stage were found in grade group 3 when compared to grade group 2, which was statistically significant (p <0.001). However, grade group 2 and grade group 3 patients with ≤10% cancer occurrences in final pathology reports after RRP did not show any statistical significance in the occurrence of T3 stage, p=0.96. Prognostic differences in grade group 2 and grade group 3 patients after RRP are significant, but not in all cases, because of their dependence on the percentage of cancer in the final pathology report after RRP of clinically localized prostate cancer.
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Affiliation(s)
- Borislav Spajić
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sven Nikles
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Igor Grubišić
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Matej Knežević
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Shoip Shoipi
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Monika Ulamec
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital Center
| | - Goran Štimac
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Igor Tomašković
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Boris Ružić
- Department of Urology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Medina Medina C, Gaona Morales J, Roselló-Sastre E, Delgado Barriga K, Escrig Sos J, Herráiz Roda JL, Llueca Abellá JA. [Protocol for the examination of surgical specimens from patients with peritoneal carcinomatosis originating in ovary, fallopian tube and peritoneum]. Rev Esp Patol 2018; 51:216-223. [PMID: 30269772 DOI: 10.1016/j.patol.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/10/2018] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
Peritoneal carcinomatosis (PC) is a malignant entity with a high rate of morbimortality. It is considered an end-stage common to several abdominal and pelvic malignant tumours, such as epithelial ovarian, fallopian tubal and peritoneal cancer. Although many of these tumors have a good response to chemotherapy, prognosis is poor due to the high rate of recurrence. Surgeons, gynecologists and oncologists are increasingly concerned with improving the survival. The surgical technique described by Sugarbaker in the eighties is a plausible option. It aims for a complete resection of macroscopic carcinomatosis (cytoreductive surgery) followed by intraoperative or perioperative intraperitoneal chemotherapy. This therapeutic option necessarily involves specific multidisciplinary units; histopathology of specimens from this surgical technique is now more frequent in our department. We describe our initial experience with PC originating from epithelial ovarian, tubal and peritoneal cancer treated with the modified Sugarbaker surgery employed in our hospital. We outline our protocol designed to achieve uniformity in procedure, and summarize the initial results.
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Affiliation(s)
- Carmen Medina Medina
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España.
| | - John Gaona Morales
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España
| | - Esther Roselló-Sastre
- Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España
| | - Katty Delgado Barriga
- Servicio de Radiología, Hospital General Universitario de Castellón, Castellón, España
| | - Javier Escrig Sos
- Servicio de Cirugía, Hospital General Universitario de Castellón, Castellón, España
| | - José Luis Herráiz Roda
- Servicio de Ginecología y Obstetricia, Hospital General Universitario de Castellón, Castellón, España
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18
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Raspollini MR, Lax SF, McCluggage WG. The central role of the pathologist in the management of patients with cervical cancer: ESGO/ESTRO/ESP guidelines. Virchows Arch 2018; 473:45-54. [PMID: 29799071 DOI: 10.1007/s00428-018-2372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/08/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
The European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) nominated an international multidisciplinary development group consisting of practicing clinicians who have demonstrated leadership and expertise in cervical cancer to produce evidence-based guidelines regarding all aspects of the management of patients with this disease. Herein, we provide a detailed analysis of the pathological reporting of cervical carcinoma specimens, focusing on practical aspects of specimen sampling and on the core pathological data which are critical for patient management.
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Affiliation(s)
- Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, University Hospital Careggi, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Sigurd F Lax
- Department of Pathology, Hospital Graz Sued-West and Medical University Graz, Graz, Austria
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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19
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Vera R, Díez L, Martín Pérez E, Plaza JC, Sanjuanbenito A, Carrato A. Surgery for pancreatic ductal adenocarcinoma. Clin Transl Oncol 2017; 19:1303-11. [PMID: 28646282 DOI: 10.1007/s12094-017-1688-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgical resection is the only potentially curative option in the treatment of pancreatic ductal adenocarcinoma. Preoperative radiological imaging allows to rule out the presence of metastases. Three resectability categories are established based on the radiological findings depending on the degree of contact between the tumor and the blood vessels. Histological confirmation of malignancy is only required in cases of borderline or non-resectable tumors, prior to neoadjuvant treatment initiation. Diagnostic laparoscopy is recommended in the presence of large tumors of the body or tail and in borderline tumors to explore the possibility of resection and to apply treatment with curative intent, as well as in those cases with high level of biomarkers to rule out peritoneal involvement. Prior to surgery preoperative nutritional measures as well as endoscopic biliary drainage can be applied to optimize patient's conditions. Cephalic pancreaticoduodenectomy is the recommended surgical technique in tumors located in the head of the pancreas. The benefits from pyloric preservation, type or reconstruction (one vs. two loops), type of anastomosis (pancreaticojejunostomy vs. pancreaticogastrostomy), intraoperative biopsy of the pancreatic resection margin or the use of intraperitoneal drainages are inconclusive. Total pancreatectomy and/or portal resection should only be performed in particular cases; however, arterial resections have shown no benefits. Radical antegrade modular pancreaticosplenectomy, that can be performed laparoscopically, is the technique used for those tumors located in the pancreatic body-tail.
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20
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Lim JS, Yoon HS, Cho S, Park HS. The Delivery Rates of Pathology Test Results to Patients: A Single-Center Experience in a Secondary Referral Center. Ann Dermatol 2017; 29:307-313. [PMID: 28566907 PMCID: PMC5438937 DOI: 10.5021/ad.2017.29.3.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/29/2016] [Accepted: 08/29/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Delivery of pathology reports to the patient is a key step in the biopsy pathway, which is important for patient safety in dermatology. Automated systems for facilitating such medical process began in 2010 in our hospital, sending short message service to scheduled patients. OBJECTIVE The purpose of this study was to evaluate the delivery of pathology reports to patients and investigate factors that influence this process and annual trends. METHODS We retrospectively reviewed the medical records of all outpatients (n=2,452) who underwent skin biopsy at our department of dermatology in 2009 and 2014. In each year group, we analyzed the proportion of revisiting patients in terms of year, sex, age, season, biopsy method and diagnosis. RESULTS In 2009, a smaller proportion of patients (205; 91.5%) who had undergone shave or excisional biopsy than of those who had undergone punch biopsy returned (781; 98.0%; p<0.001). This trend was not significant in 2014. Whereas there was no significant difference of return visit ratio between men and women in 2009, a higher proportion of women (754; 98.0%) than men (633; 95.6%) re-visited after skin biopsy to confirm their diagnosis in 2014 (p=0.008). Three patients with either a malignant tumor or suspected malignant lesion that required complete excision did not return to our clinic. CONCLUSION Pathology report delivery rates were fairly satisfactory, regardless of year, age, season, and diagnosis. Sex and biopsy method influenced the return visit ratio. More organized follow-up protocols are required to strengthen patient safety and prevent critical patient drop-out.
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Affiliation(s)
- Ji Soo Lim
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
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Orlando L, Viale G, Bria E, Lutrino ES, Sperduti I, Carbognin L, Schiavone P, Quaranta A, Fedele P, Caliolo C, Calvani N, Criscuolo M, Cinieri S. Discordance in pathology report after central pathology review: Implications for breast cancer adjuvant treatment. Breast 2016; 30:151-155. [PMID: 27750105 DOI: 10.1016/j.breast.2016.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022] Open
Abstract
AIM Pathological predictive factors are the most important markers when selecting early breast cancer adjuvant therapy. In randomized clinical trials the variability in pathology report after central pathology review is noteworthy. We evaluated the discordance rate (DR) and inter-rater agreement between local and central histopathological report and the clinical implication on treatment decision. METHODS A retrospective analysis was conducted in a series of consecutive early breast cancer tumors diagnosed by local pathologists and subsequently reviewed at the Pathology Division of European Institute of Oncology. The inter-rater agreement (k) between local and central pathology was calculated for Ki-67, grading, hormone receptors (ER/PgR) and HER2/neu. The Bland-Altman plots were derived to determine discrepancies in Ki-67, ER and PgR. DR was calculated for ER/PgR and HER2. RESULTS From 2007 to 2013, 187 pathology specimens from 10 Cancer Centers were reviewed. Substantial agreement was observed for ER (k0.612; 95% CI, 0538-0.686), PgR (k0.659; 95% CI, 0580-0.737), Ki-67 (k0.609; 95% CI, 0.534-0.684) and grading (k0.669; 95% CI, 0.569-0.769). Moderate agreement was found for HER2 (k0.546; 95% CI, 0444-0.649). DR was 9.5% (negativity to positivity) and 31.7% (positivity to negativity) for HER2 and 26.2% (negativity to positivity) and 12.5% (positivity to negativity) for ER/PgR. According to changes in Her2 and ER/PgR status, 23 (12.2%) and 33 (17.6%) systemic prescription were respectively modified. CONCLUSIONS In our retrospective analysis, central pathological review has a significant impact in the decision-making process in early breast cancer, as shown in clinical trials. Further studies are warranted to confirm these provocative results.
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Affiliation(s)
- Laura Orlando
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy.
| | - Giuseppe Viale
- Pathology Division, European Institute of Oncology, University of Milan, 20141 Milan, Italy
| | - Emilio Bria
- Medical Oncology & Breast Unit, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
| | | | - Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Luisa Carbognin
- Medical Oncology & Breast Unit, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
| | - Paola Schiavone
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy
| | | | - Palma Fedele
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy
| | - Chiara Caliolo
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy
| | - Nicola Calvani
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy
| | - Mario Criscuolo
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy
| | - Saverio Cinieri
- Medical Oncology Division & Breast Unit, 72100 Brindisi, Italy
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22
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Black JO, Coffin CM, Parham DM, Hawkins DS, Speights RA, Spunt SL. Opportunities for Improvement in Pathology Reporting of Childhood Nonrhabdomyosarcoma Soft Tissue Sarcomas: A Report From Children's Oncology Group (COG) Study ARST0332. Am J Clin Pathol 2016; 146:328-38. [PMID: 27510717 DOI: 10.1093/ajcp/aqw114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Treatment of soft tissue tumors in young patients relies on the diagnostic information conveyed in the pathology report. We examined pathology reports from Children's Oncology Group ARST0332 for inclusion of data elements required in published guidelines. METHODS Pathology reports for 551 eligible patients were examined for required data elements defined by the College of American Pathologists, including tissue type, procedure, tumor site, tumor maximum diameter, macroscopic extent of tumor, histologic type, mitotic rate, extent of necrosis, tumor grade, margin status, use of ancillary studies, and pathologic stage. RESULTS Only 65 (12%) of 551 reports included all required data elements. Of reports containing synoptic templates, 57% were complete. CONCLUSIONS This study reveals significant opportunity to improve the quality of pathology reports in young patients with soft tissue tumors. Use of templates or checklists improves completeness of reports.
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Affiliation(s)
- Jennifer O Black
- From the Department of Pathology and Laboratory Medicine, Children's Hospital of Colorado, Aurora
| | - Cheryl M Coffin
- Department of Pathology, Microbiology, Immunology, Vanderbilt University, Nashville, TN
| | - David M Parham
- Department of Pathology and Laboratory Medicine, Children's Hospital, Los Angeles, CA
| | - Douglas S Hawkins
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, WA
| | - Rose A Speights
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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23
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Abstract
Communication is an essential element of good medical practice also in pathology. In contrast to technical or diagnostic skills, communication skills are not easy to define, teach, or assess. Rules almost do not exist. In this paper, which has a rather personal character and cannot be taken as a set of guidelines, important aspects of communication in pathology are explored. This includes what should be communicated to the pathologist on the pathology request form, communication between pathologists during internal (interpathologist) consultation, communication around frozen section diagnoses, modalities of communication of a final diagnosis, with whom and how critical and unexpected findings should be communicated, (in-)adequate routes of communication for pathology diagnoses, who will (or might) receive pathology reports, and what should be communicated and how in case of an error or a technical problem. An earlier more formal description of what the responsibilities are of a pathologist as communicator and as collaborator in a medical team is added in separate tables. The intention of the paper is to stimulate reflection and discussion rather than to formulate strict rules.
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24
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De Schutter H, Van Damme N, Colpaert C, Galant C, Lambein K, Cornelis A, Neven P, Van Eycken E. Quality of pathology reporting is crucial for cancer care and registration: a baseline assessment for breast cancers diagnosed in Belgium in 2008. Breast 2015; 24:143-52. [PMID: 25572136 DOI: 10.1016/j.breast.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/04/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Given the crucial role of pathology reporting in the management of breast cancers, we aimed to investigate the quality and variability of breast cancer pathology reporting in Belgium. MATERIALS AND METHODS Detailed information on non-molecular and molecular parameters was retrieved from the pathology protocols available at the Belgian Cancer Registry for 10,007 breast cancers diagnosed in Belgium in 2008. RESULTS Substantial underreporting was shown for several clinically relevant non-molecular parameters, such as lymphovascular invasion. High-volume laboratories performed only slightly better than others, and analyses at the individual laboratory level showed clear inter-laboratory variability in reporting for all volume categories. Information on ER/PR and HER2 IHC was mentioned in respectively 91.7% and 90.8% of evaluative cases. HER2 ISH data were available for 78.5% of the cases judged to be 2+ for HER2 IHC. For cases with different specimens analysed, discordance between these specimens was highest for HER2, followed by PR. For HER2, results obtained from different laboratories were even less concordant. In addition, inter-laboratory differences were noted in the used ER/PR scoring systems, the proportion of ER-/PR+ cases, and the relation between histological grade and ER/PR positivity. Data on Ki67 were only available for 43.8% of the investigated cases, and showed inconsistent use of cut-off values. CONCLUSION Breast pathology reporting in Belgium in 2008 was suboptimal and showed considerable inter-laboratory variability. Synoptic reporting has been proposed as a facilitator towards increased reporting quality and harmonization, but the lack of aligned informatics remains a major hurdle in its concrete implementation.
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Affiliation(s)
- H De Schutter
- Belgian Cancer Registry, Koningsstraat 215 box 7, 1210, Brussels, Belgium.
| | - N Van Damme
- Belgian Cancer Registry, Koningsstraat 215 box 7, 1210, Brussels, Belgium
| | - C Colpaert
- Department of Pathology, GZA Hospitals and Antwerp University Hospital, Wilrijkstraat 10, 2650, Antwerpen, Belgium.
| | - C Galant
- Department of Pathology, University Hospital Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - K Lambein
- Department of Pathology, University Hospital Ghent, De Pintelaan 185, 9000, Gent, Belgium.
| | - A Cornelis
- Department of Pathology, Regional Hospital Heilig Hart Tienen, Kliniekstraat 45, 3300, Tienen, Belgium.
| | - P Neven
- Department of Gynaecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - E Van Eycken
- Belgian Cancer Registry, Koningsstraat 215 box 7, 1210, Brussels, Belgium
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25
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Porter KR, Chao C, Quinn VP, Hsu JWY, Jacobsen SJ. Variability in date of prostate cancer diagnosis: a comparison of cancer registry, pathology report, and electronic health data sources. Ann Epidemiol 2014; 24:855-60. [PMID: 25282324 DOI: 10.1016/j.annepidem.2014.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 09/04/2014] [Accepted: 09/10/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The date of cancer diagnosis is a critical data element for clinical care and research. Because this date can be abstracted from various data sources, its comparability from source to source is unclear. This study compared the date of diagnosis from multiple sources within the same population of prostate cancer patients. METHODS We linked cancer registry, pathology report, and electronic health data sources from the Kaiser Permanente Southern California health data systems for a cohort of 22,666 members diagnosed with prostate cancer between 2000 and 2010. The magnitude and direction of the differences in date of diagnosis were assessed for each date pairwise comparison. We reviewed 454 medical records to determine reasons for date discrepancies. RESULTS Among the date pairwise comparisons, differences in date of diagnosis spanned from 9.6 years earlier to 10 years later than each other. However, the overall median difference ranged from 1 to 16 days, thus suggesting that the vast majority of the date differences were small. Chart review results identified major categories of date discrepancies. CONCLUSIONS These data demonstrate variability in date of diagnosis across these data sources. This variability may have implications for epidemiologic estimates or patient identification in research studies using different data sources.
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Affiliation(s)
- Kimberly R Porter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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26
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Mossanen M, True LD, Wright JL, Vakar-Lopez F, Lavallee D, Gore JL. Surgical pathology and the patient: a systematic review evaluating the primary audience of pathology reports. Hum Pathol 2014; 45:2192-201. [PMID: 25149550 DOI: 10.1016/j.humpath.2014.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 12/11/2022]
Abstract
The pathology report is a critical document that helps guide the management of patients with cancer. More and more patients read their reports, intending to participate in decisions about their care. However, a substantial subset of patients may lack the ability to comprehend this often technical and complex document. We hypothesized that most literature on pathology reports discusses reports from the perspective of other physicians and not from the perspective of patients. An expert panel of physicians developed a list of search criteria, which we used to identify articles on PubMed, MEDLINE, Cochrane Reviews, and Google Scholar databases. Two reviewers independently evaluated all articles to identify for detailed review those that met search criteria. We identified the primary audience of the selected articles and the degree to which these articles addressed clarity of communication of pathology reports with patients. Of 801 articles identified in our search, 25 involved the formatting of pathology reports for clarity of communication. Recurrent themes in proposed improvements in reports included content standardization, variation in terminology, clarity of communication, and quality improvement. No articles discussed patients as their target audience. No study evaluated the health literacy level required of patients to comprehend pathology reports. In summary, there is a scarcity of patient-centered approaches to improve pathology reports. The literature on pathology reports does not include patients as a target audience. Limited resources are available to help patients comprehend their reports. Efforts to improve patient-centered communication are desirable to address this overlooked aspect of patient care.
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Affiliation(s)
- Matthew Mossanen
- Department of Urology, University of Washington, Seattle, WA 98195, USA.
| | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA 98195, USA
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
| | - Danielle Lavallee
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, WA 98195, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA 98195, USA
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27
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Mossanen M, Calvert JK, Wright JL, True LD, Lin DW, Gore JL. Readability of urologic pathology reports: the need for patient-centered approaches. Urol Oncol 2014; 32:1091-4. [PMID: 24846343 DOI: 10.1016/j.urolonc.2014.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The pathology report informs a patient's prognosis and treatment options. However, pathology reports are written using complex medical vocabulary. We evaluated the readability of pathology reports for common urologic cancers (prostate, bladder kidney, and testicular) to identify sources of confusion that could be addressed through modified patient-centered pathology reports. METHODS Pathology reports from 5 cases of each of the following procedures were analyzed: partial nephrectomy, radical nephrectomy, radical prostatectomy, ultrasound-guided prostate needle biopsy (PNBx), radical cystectomy, transurethral resection of bladder tumor, radical orchiectomy, and retroperitoneal lymph node dissection. Reports were edited for grammar and syntax, and the Flesch-Kincaid readability software calculated the reading level. Modifications were performed to identify sources of obstruction to readability. We compared modified and base reports using independent samples t tests. RESULTS Bladder cancer pathology had the highest readability index; radical prostatectomy and PNBx pathology reports had the lowest average readability indices. Modified reports that both omitted gross pathologic and immunohistochemistry content and also replaced oncologic and histology terms with lay terminology had significantly lower reading levels than base reports (P<0.05 for radical nephrectomy, partial nephrectomy, and radical orchiectomy). Modified reports did not significantly alter the reading level for radical cystectomy, transurethral resection of bladder tumor, PNBx, and retroperitoneal lymph node dissection reports. CONCLUSIONS Pathology reports are written at reading levels above the average reading capability of most Americans. Deleting descriptive pathologic terms and replacing complex medical terminology with lay terms resulted in improved readability for some urologic oncology reports but complicated readability for others. Our findings may guide the development of patient-centered pathology reports.
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Affiliation(s)
| | | | | | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA
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28
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Chatelain D, Fuks D, Farges O, Attencourt C, Pruvot FR, Regimbeau JM. Pathology report assessment of incidental gallbladder carcinoma diagnosed from cholecystectomy specimens: results of a French multicentre survey. Dig Liver Dis 2013; 45:1056-60. [PMID: 23948233 DOI: 10.1016/j.dld.2013.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/24/2013] [Accepted: 07/08/2013] [Indexed: 12/11/2022]
Abstract
AIMS To assess the accuracy of pathology reports on gallbladder specimens from patients operated on for incidental gallbladder carcinoma. METHODS Demographic data, details on pathological reports including gross and microscopic features section were recorded in 100 selected patients with incidental gallbladder carcinoma diagnosed from 2004 to 2007. RESULTS Pathology reports had a conventional format in 93% of cases, without any standardization. Turnaround time ranged from 1 to 35 days. Frozen sections were performed in 20% of cases. The reports failed to give information on prognostic histological factors: exact tumour site (missing in 55% of cases), depth of tumour infiltration within the gallbladder wall (missing in 10%), surgical margins (missing in 40% for the cystic duct margin), tumour differentiation (missing in 28%), vascular invasion (missing in 52%) and perineural invasion (missing in 51%). Lymph node status could be assessed in 44% of cases. Distances between the tumour and the cystic duct and circumferential margins were not specified in 68% and 84% of cases. Only 29% of the reports clearly stated the pTNM stage in the conclusion section. The pT stage with margin status and tumour site was only mentioned in 30% of the reports. CONCLUSION Pathology reports on gallbladder carcinoma from participating centres frequently lacked important information on key prognostic histological factors.
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Affiliation(s)
- Denis Chatelain
- Department of Pathology, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France
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