A review and audit of histopathology reporting of mastectomy specimens for breast cancer in KNH for the years 2001-2005

Abstract

Introduction: Breast cancer is the second leading malignancy in Kenyan females after cancer of cervix. The management modality depends on the tumour characteristics (stage, histological grade, histological type, vascular invasion, lymph node involvement, tumor size and the presence of hormonal receptors). The pathologist must therefore include in the histologic report all the necessary information upon which the management is based. From the data of audit studies done in other countries, it has however been shown that some of the breast cancer prognostic factors are occasionally omitted in the pathologists' report hence giving the surgeon, physicians and oncologists less data on which to base the patients' management. It has also been shown that the use of a reporting standard proforma significantly raises the completeness of reporting to almost 100%. In Kenyatta National hospital (KNH), no laboratory audit studies have ever been carried out. Consequently, findings of this review will shed light on the aspects that may require improvement. Objective: The main objective of this study was to review and audit histopathology reports and to assess the completeness of reporting by pathologists in Kenyatta National Hospital for the period 2001 to 2005. Design: This study was a hospital based retrospective descriptive cross-sectional study. Setting: It was carried out at the KNH Histopathology Laboratory. Subjects: One hundred and ninety-six mastectomy cases were audited. Methodology: All consecutive mastectomy specimen reports and blocks for the five years were retrieved and all the information needed entered in a coded data sheet. Histological sections were prepared and stained using Haematoxylin and Eosin stains. Histological diagnosis was reviewed by the principal investigator and two independent pathologists using the coded proforma and the agreed results compared with the previous reports done without the proforma. Data analysis was done using standard statistical tests Results: Invasive ductal carcinoma not otherwise specified is the most common type of breast cancer accounting for 92.3% followed by invasive lobular carcinoma, which accounted for 3.1%. The completeness of reporting of the' various tumor characteristics varied between 5.7% and 100%. The histologic type was indicated in 100%, axillary node status in 89.3%, tumor margins in 75%, histological grade in 66.3%, numerical grade in

50.5%, descriptive grade in 49%, Paget's disease in 36.8%, vascular invasion in 25%, ductal carcinoma in situ in 13.8% and tubular formation in 5.7% of all the cases audited. The use of a standard proforma significantly improved the completeness of reporting of all the tumor characteristics. It was found out that the histology request forms for mastectomy specimens were not adequately filled and that there is no systematic way of labeling the blocks/slides Conclusion: The use of a standard proforma during the time of audit improved the reporting of all the tumor characteristics. The completeness of reporting of the various tumor characteristics compared well with iindings of other studies done elsewhere. In grossing there is no systematic way of labeling the blocks/slides. The histology request forms for mastectomy specimens are not adequately filled Recommendations: A standard proforma for reporting mastectomy specimens should be introduced in the department and all pathologists should use it. The gross examination of mastectomy specimen should be standardized Clinical pathological discussions should be encouraged for the pathologists, physicians, oncologists and surgeons in order to improve the standard of care of breast cancer patients. Another audit should be carried out after a period of two years to assess the impact that will have been created by the introduction of a standard proforma for reporting mastectomy specimens.