An audit of breast cancer pathology reporting in Australia in 1995.
To measure the quality of pathology reporting of breast cancer and establish a baseline against which future changes can be measured, we audited item completeness in breast cancer reports in Australia in 1995 before the release of specific recommendations from the Australian Cancer Network. Tumour type and size were given in reports of invasive breast cancer for 93% of women, 70% had, in addition, grade and clearance of the margins while only 28% had all recommended information. The most complete items in reports were histological type of breast cancer (99.6% of cases), tumour size (94%, 95% confidence interval (CI) 92-95) and margins of excision (87%, 95% CI 85-89). Histological grade (84%, 95% CI 82-86 of cases) and presence or absence of ductal carcinoma in situ (DCIS) (79%, 95% CI 77-81) were less complete and vessel invasion (61%, 95% CI 58-63) and changes in non-neoplastic breast tissue adjacent to the breast cancer (68%, 95% CI 66-71) the least complete. Less than half the reports of DCIS reported on tumour size (49%, 95% CI 42-57), presence or absence of necrosis (41%, 95% CI 34-49) or nuclear grade (39%, 95% CI 31-46). Around 1500 reports were identified as issued by 147 laboratories and 392 pathologists; 69% of pathologists issued fewer than two reports a month in the audit. We concluded that infrequency of reporting may have contributed to incompleteness of reporting. In addition, we found significant variation across Australian states with some indication that reporting was consistently poor in one state. The audit highlighted areas for improvement for breast cancer reporting in Australia. Research evidence suggests that multifaceted strategies are needed to assist practitioners with implementing more uniform reporting standards.
NHMRC National Breast Cancer Centre, NSW, Australia.
A
A
Kricker
B
B
Armstrong
C
C
Smith
M
M
Bilous
C
C
Camaris
A
A
Mayer
T
T
Psarianos
D000368:Aged; D001315:Australia; D001706:Biopsy / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data; D008408:Mastectomy / Q000706:statistics & numerical data; D008485:Medical Audit / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008499:Medical Records / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D009361:Neoplasm Invasiveness