1
|
Schaad N, Berezowska S, Perren A, Hewer E. Impact of template-based synoptic reporting on completeness of surgical pathology reports. Virchows Arch 2024; 484:31-36. [PMID: 37017774 PMCID: PMC10791929 DOI: 10.1007/s00428-023-03533-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
Synoptic reporting increases completeness and standardization of surgical pathology reports and thereby contributes to an increased quality of clinical cancer care. Nevertheless, its widespread practical implementation remains a challenge, which is in part related to the effort required for setup and maintenance of database structures. This prompted us to assess the effect of a simple template-based, database-free system for synoptic reporting on completeness of surgical pathology reports. For this purpose, we analyzed 200 synoptic reports (100 colon and 100 lung cancer resections each) for completeness as required by the pertinent College of American Pathologists (CAP) protocols and compared these to a control dataset of 200 narrative reports. Introduction of template-based synoptic reporting resulted in improved completeness (98% of mandatory data elements) as compared to narrative reports (77%). Narrative reports showed a high degree of completeness for data elements covered by previously existing dictation templates. In conclusion, template-based synoptic reporting without underlying database structure can be a useful transitory phase in the implementation of synoptic reporting. It can result in a similar degree of completeness as reported in the literature for database solutions and provides other benefits of synoptic reporting while facilitating its implementation.
Collapse
Affiliation(s)
- Nicole Schaad
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 25, 1011 Lausanne, Switzerland
| | - Aurel Perren
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Ekkehard Hewer
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland.
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 25, 1011 Lausanne, Switzerland.
| |
Collapse
|
2
|
Richter C, Mezger E, Schüffler PJ, Sommer W, Fusco F, Hauner K, Schmid SC, Gschwend JE, Weichert W, Schwamborn K, Pförringer D, Schlitter AM. Pathological Reporting of Radical Prostatectomy Specimens Following ICCR Recommendation: Impact of Electronic Reporting Tool Implementation on Quality and Interdisciplinary Communication in a Large University Hospital. Curr Oncol 2022; 29:7245-7256. [PMID: 36290848 PMCID: PMC9600383 DOI: 10.3390/curroncol29100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 01/13/2023] Open
Abstract
Prostate cancer represents one of the most common malignant tumors in male patients in Germany. The pathological reporting of radical prostatectomy specimens following a structured process constitutes an excellent prototype for the introduction of software-based standardized structured reporting in pathology. This can lead to reports of higher quality and could create a fundamental improvement for future AI applications. A software-based reporting template was used to generate standardized structured pathological reports of radical prostatectomy specimens of patients treated at the University Hospital Klinikum rechts der Isar of Technische Universität München, Germany. Narrative reports (NR) and standardized structured reports (SSR) were analyzed with regard to completeness, and clinicians' satisfaction with each report type was evaluated. SSR show considerably higher completeness than NR. A total of 10 categories out of 32 were significantly more complete in SSR than in NR (p < 0.05). Clinicians awarded overall high scores in NR and SSR reports. One rater acknowledged a significantly higher level of clarity and time saving when comparing SSR to NR. Our findings highlight that the standardized structured reporting of radical prostatectomy specimens, qualifying as level 5 reports, significantly increases objectively measured content quality and the level of completeness. The implementation of nationwide SSR in Germany, particularly in oncologic pathology, can serve pathologists, clinicians, and patients.
Collapse
Affiliation(s)
- Caroline Richter
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Eva Mezger
- Smart Reporting GmbH, 80538 Munich, Germany
| | - Peter J. Schüffler
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Wieland Sommer
- Smart Reporting GmbH, 80538 Munich, Germany
- Department of Radiology, LMU University Hospital, 81377 Munich, Germany
| | - Federico Fusco
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Katharina Hauner
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Sebastian C. Schmid
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Jürgen E. Gschwend
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Wilko Weichert
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Kristina Schwamborn
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - Dominik Pförringer
- Clinic and Policlinic for Trauma Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany
| | - Anna Melissa Schlitter
- Institute of General and Surgical Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
- Correspondence:
| |
Collapse
|
3
|
Association of Sentinel Node Biopsy and Pathological Report Completeness with Survival Benefit for Cutaneous Melanoma and Factors Influencing Their Different Uses in European Populations. Cancers (Basel) 2022; 14:cancers14184379. [PMID: 36139539 PMCID: PMC9497177 DOI: 10.3390/cancers14184379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: Standard care for cutaneous melanoma includes an accurate pathology report (PR) and sentinel lymph node biopsy (SLNB) for staging clinically node-negative >1 mm melanomas. We aimed to investigate the frequency of these indicators across European countries, also assessing consequences for survival. Methods: We analyzed 4245 melanoma cases diagnosed in six European countries in 2009−2013. Multivariable logistic regression was used to estimate the Odds Ratio (OR) of receiving complete PR with eight items or SLNB and model-based survival to estimate the five-year relative excess risks of death (RER). Results: Overall, 12% patients received a complete PR (range 2.3%, Estonia—20.1%, Italy); SLNB was performed for 68.8% of those with cN0cM0 stage (range 54.4%, Spain—81.7%, Portugal). The adjusted OR of receiving a complete PR was lower than the mean in Estonia (OR 0.11 (0.06−0.18)) and higher in Italy (OR 6.39 (4.90−8.34)) and Portugal (OR 1.39 (1.02−1.89)); it was higher for patients operated on in specialized than general hospitals (OR 1.42 (1.08−1.42)). In the multivariate models adjusted for age, sex, country and clinical-pathological characteristics, the RER resulted in being higher than the reference for patients not receiving a complete PR with eight items (RER 1.72 (1.08−2.72)), or for those not undergoing SLNB (RER 1.76 (1.26−2.47)) Patients with non-metastatic node-negative thickness >1 mm melanoma who did not undergo SLNB had a higher risk of death (RER (RER 1.69 (1.02−2.80)) than those who did. Conclusions: Accurate pathology profiling and SLNB carried survival benefit. Narrowing down between-countries differences in adhesion to guidelines might achieve better outcomes.
Collapse
|
4
|
Dataset for the Reporting of Merkel Cell Carcinoma: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Am J Surg Pathol 2022; 46:1583-1591. [PMID: 36001458 DOI: 10.1097/pas.0000000000001959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accurate and complete pathology reports are critical for the optimal management of cancer patients. Protocols for the pathologic reporting of Merkel cell carcinoma (MCC) have been developed independently by the Royal College of Pathologists (UK) and the College of American Pathologists. In this study, data elements for pathologic reporting of MCC were analyzed by an international panel of pathologists and clinicians with the aim of developing a common, internationally agreed upon dataset useful for clinical practice. The International Collaboration on Cancer Reporting expert review panel developed a protocol containing "core" (required) and "noncore" (recommended) elements. Core elements were defined as those that had evidentiary support and were unanimously agreed upon by the review panel as essential for the clinical management, staging, and/or assessment of prognosis in patients with MCC. Noncore elements were those considered to be clinical of interest, but with lesser degrees of supportive evidence or nonactionable implications. Ten core data elements for pathology reports on primary MCC were defined. Development and agreement on this evidence-based protocol at an international level was accomplished in a timely and efficient manner. The template developed for melanoma reporting was used as a structural base for this initiative. It is applicable to, and may facilitate the development of, protocols for other tumor types. Widespread utilization of an internationally agreed upon structured pathology dataset for MCC can be expected to lead to improved patient management. It should also facilitate collaborative clinical research.
Collapse
|
5
|
McKay DR, Nguyen P, Wang A, Hanna TP. A population-based study of administrative data linkage to measure melanoma surgical and pathology quality. PLoS One 2022; 17:e0263713. [PMID: 35180251 PMCID: PMC8856577 DOI: 10.1371/journal.pone.0263713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Continuous quality improvement is important for cancer systems. However, collecting and compiling quality indicator data can be time-consuming and resource-intensive. Here we explore the utility and feasibility of linked routinely collected health data to capture key elements of quality of care for melanoma in a single-payer, universal health care setting.
Method
This pilot study utilized a retrospective population-based cohort from a previously developed linked administrative data set, with a 65% random sample of all invasive cutaneous melanoma cases diagnosed 2007–2012 in the province of Ontario. Data from the Ontario Cancer Registry was utilized, supplemented with linked pathology report data from Cancer Care Ontario, and other linked administrative data describing health care utilization. Quality indicators identified through provincial guidelines and international consensus were evaluated for potential collection with administrative data and measured where possible.
Results
A total of 7,654 cases of melanoma were evaluated. Ten of 25 (40%) candidate quality indicators were feasible to be collected with the available administrative data. Many indicators (8/25) could not be measured due to unavailable clinical information (e.g. width of clinical margins). Insufficient pathology information (6/25) or health structure information (1/25) were less common reasons. Reporting of recommended variables in pathology reports varied from 65.2% (satellitosis) to 99.6% (body location). For stage IB-II or T1b-T4a melanoma patients where SLNB should be discussed, approximately two-thirds met with a surgeon experienced in SLNB. Of patients undergoing full lymph node dissection, 76.2% had adequate evaluation of the basin.
Conclusions
We found that use of linked administrative data sources is feasible for measurement of melanoma quality in some cases. In those cases, findings suggest opportunities for quality improvement. Consultation with surgeons offering SLNB was limited, and pathology report completeness was sub-optimal, but was prior to routine synoptic reporting. However, to measure more quality indicators, text-based data sources will require alternative approaches to manual collection such as natural language processing or standardized collection. We recommend development of robust data platforms to support continuous re-evaluation of melanoma quality indicators, with the goal of optimizing quality of care for melanoma patients on an ongoing basis.
Collapse
Affiliation(s)
- Douglas R. McKay
- Division of Plastic Surgery, Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Paul Nguyen
- ICES at Queen’s University, Kingston, Ontario, Canada
| | - Ami Wang
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Timothy P. Hanna
- ICES at Queen’s University, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, Ontario, Canada
- * E-mail:
| |
Collapse
|
6
|
Echeverria D, Rossi KR, Carroll A, Luse T, Rennix C. Development of a Semiautomated Search Tool to Identify Grading From Pathology Reports for Tumors of the CNS and Prostate Cancers. JCO Clin Cancer Inform 2021; 5:1189-1196. [PMID: 34882482 DOI: 10.1200/cci.21.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study demonstrates the functionality of semiautomated algorithms to classify cancer-specific grading from electronic pathology reports generated from military treatment facilities. Two Perl-based algorithms are validated to classify WHO grade for tumors of the CNS and Gleason grades for prostate cancer. METHODS Case-finding cohorts were developed using diagnostic codes and matched by unique identifiers to obtain pathology records generated in the Military Health System for active duty service members from 2013 to 2018. Perl-based algorithms were applied to classify document-based pathology reports to identify malignant CNS tumors and prostate cancer, followed by a hand-review process to determine accuracy of the algorithm classifications. Inter-rater reliability, sensitivity, specificity, positive predictive values (PPVs), and negative predictive values were computed following abstractor adjudication. RESULTS The high PPV for the Perl-based algorithms to classify CNS tumors (PPV > 98%) and prostate cancer (PPV > 99%) supports this approach to classify malignancies for cancer surveillance operations, mediated by a hand-reviewed semiautomated process to increase sensitivity by capturing ungraded cancers. Early detection was pronounced where 33.6% and 50.7% of malignant records retained a CNS WHO grade of II or a Gleason score of 6, respectively. Sensitivity metrics met criteria (> 75%) for brain (79.9%, 95% CI, 73.0 to 85.7) and prostate (96.7%, 95% CI, 94.9 to 98.0) cancers. CONCLUSION Semiautomated, document-based text classification using Perl coding successfully leveraged identification of WHO and Gleason grades to classify pathology records for CNS tumors and prostate cancer. The process is recommended for data quality initiatives to support cancer reporting functions, epidemiology, and research.
Collapse
Affiliation(s)
- Diana Echeverria
- Battelle, Columbus, OH.,Departmnet of Environmental Health, University of Washington, Seattle, WA
| | | | - Anna Carroll
- EpiData Center Department, Navy and Marine Corps Public Health Center, Portsmouth, VA
| | - Tina Luse
- EpiData Center Department, Navy and Marine Corps Public Health Center, Portsmouth, VA
| | - Christopher Rennix
- Pioneer Technologies Corporation, Olympia, WA.,Keene State College, Keene, NH
| |
Collapse
|
7
|
Hewer E, Rump A, Langer R. [Standardized structured reports for gastrointestinal tumors]. DER PATHOLOGE 2021; 43:57-62. [PMID: 34609569 PMCID: PMC8789623 DOI: 10.1007/s00292-021-00986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
Synoptic reporting in pathology as opposed to traditional narrative reporting is defined by a laboratory value-like format and use of standardized checklists. It contributes to completeness and comprehensibility of pathology reports and ultimately patient care. As of today, two major institutions publish synoptic reporting templates, the College of American Pathologists (CAP) and the International Collaboration for Cancer Reporting (ICCR). Synoptic protocols are available for all major cancer types and provide not only a standardized terminology and a checklist for completeness of reports, but also facilitate uniform utilization of diagnostic criteria. Additionally, both CAP and ICCR protocols are accompanied by detailed and up-to-date reference lists and thereby represent a valuable source of information even when synoptic reporting is not used. The benefits and challenges of implementation of synoptic reporting are discussed, in particular with regard to reporting in German.
Collapse
Affiliation(s)
- Ekkehard Hewer
- Institut universitaire de pathologie, Centre hospitalier universitaire vaudois (CHUV) et Université de Lausanne, Rue du Bugnon 25, 1011, Lausanne, Schweiz.
| | - Anna Rump
- Institut für Pathologie und Molekularpathologie, Kepler Universitätsklinikum und Johannes-Kepler-Universität, Linz, Österreich
| | - Rupert Langer
- Institut für Pathologie und Molekularpathologie, Kepler Universitätsklinikum und Johannes-Kepler-Universität, Linz, Österreich
| |
Collapse
|
8
|
Rossi KR, Echeverria D, Carroll A, Luse T, Rennix C. Development and Evaluation of Perl-Based Algorithms to Classify Neoplasms From Pathology Records in Synoptic Report Format. JCO Clin Cancer Inform 2021; 5:295-303. [PMID: 33760628 DOI: 10.1200/cci.20.00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Synoptic reporting provides a mechanism for uniform and structured pathology diagnostics. This paper demonstrates the functionality of Perl alternation and grouping expressions to classify electronic pathology reports generated from military treatment facilities. Eight Perl-based algorithms are validated to classify malignant melanoma, Hodgkin lymphoma, non-Hodgkin lymphoma, leukemia, and malignant neoplasms of the breast, ovary, testis, and thyroid. METHODS Case finding cohorts were developed using diagnostic codes for neoplasm groups and matched by unique identifiers to obtain pathology records. Preprocessing techniques and Perl-based algorithms were applied to classify records as malignant, in situ, suspect, or nonapplicable, followed by a hand-review process to determine the accuracy of the algorithm classifications. Interrater reliability, sensitivity, specificity, positive predictive values, and negative predictive values were computed following abstractor adjudication. RESULTS The specificity of the Perl-based algorithms was consistently high, over 98%. Very few benign results were classified as malignant or in situ by the Perl-based algorithms; the leukemia algorithm classification was the only group to demonstrate a positive predictive value below 95%, at 91.9%. Three algorithm classification groups demonstrated a sensitivity of < 80%, including malignant neoplasm of the ovary (33.3%), leukemia (52.8%), and non-Hodgkin lymphoma (62.9%). The pathology records for these results included substantial linguistic variation. CONCLUSION This paper contextualizes the utility and value of an algorithm logic built around synoptic reporting to identify neoplasms from electronic pathology results. The major strength includes the application of Perl-based coding in SAS, an accessible software application, to develop highly specific algorithms across institutional variation in diagnostic documentation.
Collapse
Affiliation(s)
| | | | - Anna Carroll
- EpiData Center Department, Navy and Marine Corps Public Health Center, Portsmouth, VA
| | - Tina Luse
- EpiData Center Department, Navy and Marine Corps Public Health Center, Portsmouth, VA
| | | |
Collapse
|
9
|
Henkel M, Mertz KD, Laux J, Klan M, Breit C, Marston K, Matthias MO, Dugas SG, Manneck S, Stieltjes B, Seifert H, Wetterauer C. Toward a Platform for Structured Data Acquisition in Oncology: A Pilot Study on Prostate Cancer Screening. Oncology 2021; 99:802-812. [PMID: 34515209 DOI: 10.1159/000518381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Physicians spend an ever-rising amount of time to collect relevant information from highly variable medical reports and integrate them into the patient's health condition. OBJECTIVES We compared synoptic reporting based on data elements to narrative reporting in order to evaluate its capabilities to collect and integrate clinical information. METHODS We developed a novel system to align medical reporting to data integration requirements and tested it in prostate cancer screening. We compared expenditure of time, data quality, and user satisfaction for data acquisition, integration, and evaluation. RESULTS In a total of 26 sessions, 2 urologists, 2 radiologists, and 2 pathologists conducted the diagnostic work-up for prostate cancer screening with both narrative reporting and the novel system. The novel system led to a significantly reduced time for collection and integration of patient information (91%, p < 0.001), reporting in radiology (44%, p < 0.001) and pathology (33%, p = 0.154). The system usage showed a high positive effect on evaluated data quality parameters completeness, format, understandability, as well as user satisfaction. CONCLUSION This study provides evidence that synoptic reporting based on data elements is effectively reducing time for collection and integration of patient information. Further research is needed to assess the system's impact for different patient journeys.
Collapse
Affiliation(s)
- Maurice Henkel
- Research & Analytic Services University Hospital Basel, Basel, Switzerland, .,Institute of Pathology, Kantonsspital Baselland, Liestal, Switzerland, .,Institute of Radiology, University Hospital Basel, Basel, Switzerland,
| | - Kirsten D Mertz
- Institute of Pathology, Kantonsspital Baselland, Liestal, Switzerland
| | - Jonas Laux
- Research & Analytic Services University Hospital Basel, Basel, Switzerland
| | - Matthias Klan
- Research & Analytic Services University Hospital Basel, Basel, Switzerland
| | - Christian Breit
- Institute of Radiology, University Hospital Basel, Basel, Switzerland
| | - Katharina Marston
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Marc O Matthias
- Institute of Urology, University Hospital Basel, Basel, Switzerland
| | - Sarah G Dugas
- Institute of Urology, University Hospital Basel, Basel, Switzerland
| | - Sebastian Manneck
- Institute of Radiology, University Hospital Basel, Basel, Switzerland
| | - Bram Stieltjes
- Research & Analytic Services University Hospital Basel, Basel, Switzerland.,Institute of Radiology, University Hospital Basel, Basel, Switzerland
| | - Helge Seifert
- Institute of Urology, University Hospital Basel, Basel, Switzerland
| | | |
Collapse
|
10
|
Meuten DJ, Moore FM, Donovan TA, Bertram CA, Klopfleisch R, Foster RA, Smedley RC, Dark MJ, Milovancev M, Stromberg P, Williams BH, Aubreville M, Avallone G, Bolfa P, Cullen J, Dennis MM, Goldschmidt M, Luong R, Miller AD, Miller MA, Munday JS, Roccabianca P, Salas EN, Schulman FY, Laufer-Amorim R, Asakawa MG, Craig L, Dervisis N, Esplin DG, George JW, Hauck M, Kagawa Y, Kiupel M, Linder K, Meichner K, Marconato L, Oblak ML, Santos RL, Simpson RM, Tvedten H, Whitley D. International Guidelines for Veterinary Tumor Pathology: A Call to Action. Vet Pathol 2021; 58:766-794. [PMID: 34282984 DOI: 10.1177/03009858211013712] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as "living documents" on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care.
Collapse
Affiliation(s)
| | | | | | - Christof A Bertram
- Freie Universität Berlin, Berlin, Germany.,University of Veterinary Medicine, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | - Pompei Bolfa
- Ross University, Basseterre, Saint Kitts and Nevis
| | - John Cullen
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nick Dervisis
- VA-MD College of Veterinary Medicine, Blacksburg, VA, USA
| | | | | | | | | | | | - Keith Linder
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | - Renato L Santos
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - R Mark Simpson
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Harold Tvedten
- Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | |
Collapse
|
11
|
Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
Collapse
Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
12
|
Torous VF, Allan RW, Balani J, Baskovich B, Birdsong GG, Dellers E, Dryden M, Edgerton ME, Giannico GA, Heayn M, Jackson CR, Klepeis VE, Olson JE, Pettus JR, Simpson RW, Sirintrapun SJ, Smith DL, Srigley JR, Berman MA. Exploring the College of American Pathologists Electronic Cancer Checklists: What They Are and What They Can Do for You. Arch Pathol Lab Med 2021; 145:392-398. [PMID: 33238006 DOI: 10.5858/arpa.2020-0239-ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Vanda F Torous
- From the Department of Pathology, Massachusetts General Hospital, Boston (Torous, Klepeis)
| | - Robert W Allan
- the Department of Pathology, Malcom Randall Veterans Affairs Medical Center, University of Florida, Gainesville (Allan)
| | - Jyoti Balani
- the Department of Pathology, UT Southwestern Medical Center, Dallas, Texas (Balani)
| | - Brett Baskovich
- the Department of Pathology, University of Florida College of Medicine, Jacksonville (Baskovich)
| | - George G Birdsong
- the Department of Pathology, Atlanta Emory University School of Medicine at Grady Hospital, Atlanta, Georgia (Birdsong)
| | | | - Mignon Dryden
- the North American Association of Central Cancer Registries, Portland, Oregon (Dryden)
| | - Mary E Edgerton
- the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Edgerton)
| | - Giovanna A Giannico
- the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Giannico)
| | - Michelle Heayn
- the Department of Pathology, Einstein Medical Center Montgomery, East Norriton, Pennsylvania (Heayn)
| | - Christopher R Jackson
- the Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Jackson, Pettus)
| | - Veronica E Klepeis
- From the Department of Pathology, Massachusetts General Hospital, Boston (Torous, Klepeis)
| | - Jordan E Olson
- the Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania (Olson)
| | - Jason R Pettus
- the Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Jackson, Pettus)
| | - Ross W Simpson
- the Department of Pathology, Park Nicollet-Methodist Hospital, St Louis Park, Minnesota (Simpson)
| | - S Joseph Sirintrapun
- the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Sirintrapun)
| | - Deven L Smith
- Pathology Consultants PC, Springfield, Oregon (Smith)
| | - John R Srigley
- the Department of Pathology, Trillium Health Partners and University of Toronto, Toronto, Ontario, Canada (Srigley)
| | - Michael A Berman
- and the Department of Pathology, Jefferson Hospital, Allegheny Health Network, Jefferson Hills, Pennsylvania (Berman)
| |
Collapse
|
13
|
Taylor LA, Eguchi MM, Reisch LM, Radick AC, Shucard H, Kerr KF, Piepkorn MW, Knezevich SR, Elder DE, Barnhill RL, Elmore JG. Histopathologic synoptic reporting of invasive melanoma: How reliable are the data? Cancer 2021; 127:3125-3136. [PMID: 33945628 DOI: 10.1002/cncr.33612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/05/2021] [Accepted: 03/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Synoptic reporting is recommended by many guideline committees to encourage the thorough histologic documentation necessary for optimal management of patients with melanoma. METHODS One hundred fifty-one pathologists from 40 US states interpreted 41 invasive melanoma cases. For each synoptic reporting factor, the authors identified cases with "complete agreement" (all participants recorded the same value) versus any disagreement. Pairwise agreement was calculated for each case as the proportion of pairs of responses that agreed, where paired responses were generated by the comparison of each reviewer's response with all others. RESULTS There was complete agreement among all reviewers for 22 of the 41 cases (54%) on Breslow thickness dichotomized at 0.8 mm, with pairwise agreement ranging from 49% to 100% across the 41 cases. There was complete agreement for "no ulceration" in 24 of the 41 cases (59%), with pairwise agreement ranging from 42% to 100%. Tumor transected at base had complete agreement for 26 of the 41 cases (63%), with pairwise agreement ranging from 31% to 100%. Mitotic rate, categorized as 0/mm2 , 1/mm2 , or 2/mm2 , had complete agreement for 17 of the 41 cases (41%), with pairwise agreement ranging from 36% to 100%. Regression saw complete agreement for 14 of 41 cases (34%), with pairwise agreement ranging from 40% to 100%. Lymphovascular invasion, perineural invasion, and microscopic satellites were rarely reported as present. Respectively, these prognostic factors had complete agreement for 32 (78%), 37 (90%), and 18 (44%) of the 41 cases, and the ranges of pairwise agreement were 47% to 100%, 70% to 100%, and 53% to 100%, respectively. CONCLUSIONS These findings alert pathologists and clinicians to the problem of interobserver variability in recording critical prognostic factors. LAY SUMMARY This study addresses variability in the assessment and reporting of critical characteristics of invasive melanomas that are used by clinicians to guide patient care. The authors characterize the diagnostic variability among pathologists and their reporting methods in light of recently updated national guidelines. Results demonstrate considerable variability in the diagnostic reporting of melanoma with regard to the following: Breslow thickness, mitotic rate, ulceration, regression, and microscopic satellites. This work serves to alert pathologists and clinicians to the existence of variability in reporting these prognostic factors.
Collapse
Affiliation(s)
- Laura A Taylor
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Megan M Eguchi
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Lisa M Reisch
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Andrea C Radick
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Hannah Shucard
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Dermatopathology Northwest, Bellevue, Washington
| | | | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond L Barnhill
- Department of Pathology, Curie Institute, Paris Sciences and Lettres Research University, Paris, France.,Department of Translational Research, Curie Institute, Paris Sciences and Lettres Research University, Paris, France.,Faculty of Medicine, University of Paris Descartes, Paris, France
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
14
|
Renshaw AA, Gatcliffe T, Gould EW. Synoptic Report Response Options Directly Impact Patient Care. Arch Pathol Lab Med 2020. [DOI: 10.5858/arpa.2020-0181-le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew A. Renshaw
- Department of Pathology and Surgery, Baptist Health of South Florida, Miami
| | | | - Edwin W. Gould
- Department of Pathology and Surgery, Baptist Health of South Florida, Miami
| |
Collapse
|
15
|
Renshaw AA, Gould EW. In Reply. Arch Pathol Lab Med 2020; 144:273-274. [PMID: 32101055 DOI: 10.5858/arpa.2019-0558-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew A Renshaw
- Departments of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida
| | - Edwin W Gould
- Departments of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida
| |
Collapse
|
16
|
Abstract
The pathological diagnosis of melanoma can be challenging. The provision of an appropriate biopsy and pertinent history can assist in establishing an accurate diagnosis and reliable estimate of prognosis. In their reports, pathologists should document both the criteria on which the diagnosis was based as well as important prognostic parameters. For melanoma, such prognostic parameters include tumor thickness, ulceration, mitotic rate, lymphovascular invasion, neurotropism, and tumor-infiltrating lymphocytes. Disease staging is important for risk stratifying melanoma patients into prognostic groups and patient management recommendations are often stage based. The 8th edition American Joint Committee on Cancer (AJCC) Melanoma Staging System was implemented in 2018 and several important changes were made. Tumor thickness and ulceration remain the key T category criteria. T1b melanomas were redefined as either ulcerated melanomas <1.0 mm thick or nonulcerated melanomas 0.8-1.0 mm thick. Although mitotic rate was removed as a T category criterion in the 8th edition, it remains a very important prognostic factor and should continue to be documented in primary melanoma pathology reports. It was also recommended in the 8th edition that tumor thickness be recorded to the nearest 0.1 mm (rather than the nearest 0.01 mm). In the future, incorporation of additional prognostic parameters beyond those utilized in the current version of the staging system into (web based) prognostic models/clinical tools will likely facilitate more personalized prognostic estimates. Evaluation of molecular markers of prognosis is an active area of current research; however, additional data are needed before it would be appropriate to recommend use of such tests in routine clinical practice.
Collapse
|
17
|
Cabrera S, Smith S, Ryman W. Synoptic reporting in Mohs micrographic surgery. Australas J Dermatol 2019; 61:43-45. [PMID: 31429917 DOI: 10.1111/ajd.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
There is currently no standardised reporting format for Mohs surgery with its operation reports mostly written in a narrative form making them prone to unintentional errors and omission of necessary data. Synoptic histology reporting is used to describe excised skin cancers such as melanomas and, more recently, squamous cell and basal cell carcinomas. Since Mohs surgery is utilised as the gold standard treatment for locally invasive squamous and basal cell carcinomas, we propose the use of our model of synoptic reporting to ensure the completeness and consistency of Mohs surgery operation reports.
Collapse
Affiliation(s)
- Samantha Cabrera
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Saxon Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - William Ryman
- Department of Dermatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| |
Collapse
|
18
|
Hewer E. The Oncologist's Guide to Synoptic Reporting: A Primer. Oncology 2019; 98:396-402. [PMID: 31177262 DOI: 10.1159/000500884] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022]
Abstract
Synoptic reporting in tumour pathology is defined by (1) completeness in terms of data elements as well as (2) a specific, laboratory value-like format. Adoption of synoptic reporting leads to more complete reporting of essential parameters, improved standardisation of diagnostic criteria and terminology, as well as easier retrieval of information. It is therefore associated with a high degree of satisfaction among end users including surgeons and oncologists and contributes to improvement of clinical care. Furthermore, synoptic reporting is an important step towards higher levels of data capture, which facilitate data exchange and analysis for quality assurance, cancer epidemiology and clinical and basic research. Increased interest in and adoption of synoptic reporting on a global level is stimulated by the International Collaboration on Cancer Reporting (ICCR) which publishes freely available, evidence-based datasets for reporting an increasing number of different cancer types. These developments pave the path for increased future application of synoptic reporting across the entire field of oncologic medicine, where it will likely deploy similar benefits to those in pathology. Given that synoptic reporting can be considered the most precise means available for reporting of medical findings, it may be predicted to be critical for the promise of precision medicine to become real.
Collapse
Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland,
| |
Collapse
|
19
|
Benton SJ, Lafreniere AJ, Grynspan D, Bainbridge SA. A synoptic framework and future directions for placental pathology reporting. Placenta 2019; 77:46-57. [DOI: 10.1016/j.placenta.2019.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/17/2022]
|
20
|
Abstract
Laboratory testing plays an essential role in the diagnosis and management of patients with multiple myeloma. A variety of chemistry and molecular assays are routinely used to monitor patient progress, response to treatment and relapse. Here, we have reviewed current literature and core guidelines on the details of laboratory testing in myeloma-related investigations. This includes the use and value of protein electrophoresis, serum free light chain and cytogenetic testing. Furthermore, we discuss other traditional chemistry assays essential to myeloma investigation, and potential interferences that may arise due to the disease nature of myeloma, that is, the presence of a monoclonal immunoglobulin. Finally, we discuss the importance of communication in protein electrophoresis results, where laboratorians are required to relate clinically relevant myeloma-relevant information to the ordering physician on the background of a complex pattern of serum or urine proteins. Laboratory testing in myeloma-related investigation relies on several traditional chemistry assays. However, we anticipate new tests and technologies to become available in the future with improved analytical sensitivity, as well as improved clinical sensitivity in identifying patients who are at high risk of progression to multiple myeloma.
Collapse
Affiliation(s)
| | - Ronald A Booth
- Division of Biochemistry, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kristin Hauff
- Interior Health Corporate Office, Kelowna, BC, Canada
| | - Philip Berardi
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada; Division of Anatomical Pathology, The Ottawa Hospital/University of Ottawa, Ottawa, ON, Canada
| | - Alissa Visram
- Division of Haematology, The Ottawa Hospital General Campus, Ottawa, ON, Canada
| |
Collapse
|
21
|
Renshaw AA, Gould EW. Improving Discrete Data Capture in Synoptic Reports With Optional Free-Text Modifiers. JCO Clin Cancer Inform 2019; 2:1-6. [PMID: 30652544 DOI: 10.1200/cci.17.00127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Upfront, discrete data capture in synoptic reporting fails when pathologists choose a response not associated with discrete data. We sought to determine the factors associated with this event. METHODS The results of all "Other" entries in four common tumor sites in synoptic reports were reviewed. RESULTS "Other" entries occurred in 329 of 13,421 questions (2.5%). In 306 of these 329 questions (93.0%), the pathologist appeared to choose this response because they wished to add additional information to an already existing response that was associated with discrete data capture. As a result, the addition of a free-text modifiers to existing responses would allow pathologist to add this additional information while still selecting a response associated with discrete data capture, significantly improving the total discrete data capture (13,092 of 13,421 questions [97.5%] v 13,398 of 13,421 questions [99.8%]; P < .001). CONCLUSION The addition of free-text modifiers to structured responses in synoptic reports could significantly improve the discrete data capture rate.
Collapse
Affiliation(s)
- Andrew A Renshaw
- Andrew A. Renshaw and Edwin W. Gould, Miami Cancer Institute and Baptist Hospital, Miami, FL
| | - Edwin W Gould
- Andrew A. Renshaw and Edwin W. Gould, Miami Cancer Institute and Baptist Hospital, Miami, FL
| |
Collapse
|
22
|
Renshaw AA, Mena-Allauca M, Gould EW, Sirintrapun SJ. Synoptic Reporting: Evidence-Based Review and Future Directions. JCO Clin Cancer Inform 2018; 2:1-9. [PMID: 30652566 PMCID: PMC6873952 DOI: 10.1200/cci.17.00088] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrew A. Renshaw
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mercy Mena-Allauca
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edwin W. Gould
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S. Joseph Sirintrapun
- Andrew A. Renshaw, Mercy Mena-Allauca, and Edwin W. Gould, Baptist Health South Florida, Miami, FL; and S. Joseph Sirintrapun, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
23
|
Patel A, Rockall A, Guthrie A, Gleeson F, Worthy S, Grubnic S, Burling D, Allen C, Padhani A, Carey B, Cavanagh P, Peake MD, Brown G. Can the completeness of radiological cancer staging reports be improved using proforma reporting? A prospective multicentre non-blinded interventional study across 21 centres in the UK. BMJ Open 2018; 8:e018499. [PMID: 30282676 PMCID: PMC6169672 DOI: 10.1136/bmjopen-2017-018499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Following a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known to be inconsistently documented. We tested whether the completeness of cancer staging radiology reports could be improved through a nationally introduced pilot of proforma-based reporting for a selection of six common cancers. DESIGN Prospective interventional study comparing the completeness of radiology cancer staging reports before and after the introduction of proforma reporting. SETTING Twenty-one UK National Health Service hospitals. PARTICIPANTS 1283 cancer staging radiology reports were submitted. MAIN OUTCOME MEASURES Radiology staging reports across the six cancers types were evaluated before and after the implementation of proforma-based reporting. Report completeness was assessed using scoring forms listing the presence or absence of predetermined key staging data. Qualitative data regarding proforma implementation and usefulness were collected from questionnaires provided to radiologists and end-users. RESULTS Electronic proforma-based reporting was successfully implemented in 15 of the 21 centres during the evaluation period. A total of 787 preproforma and 496 postproforma staging reports were evaluated. In the preproforma group, only 48.7% (5586/11 470) of key staging items were present compared with 87.3% (6043/6920) in the postproforma group. Thus, the introduction of proforma reporting produced a 78% improvement in staging completeness . This increase was seen across all cancer types and centres. The majority of participants found proforma reporting improved cancer reporting quality for their clinical practice . CONCLUSION The implementation of proforma reporting results in a significant improvement in the completeness of cancer staging reports. Proforma-based assessment of cancer stage enables objective comparisons of patient outcomes across centres. It should therefore become an auditable quality standard for cancer care.
Collapse
Affiliation(s)
- Anisha Patel
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - Andrea Rockall
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - Ashley Guthrie
- Department of Radiology, St James’ University Hospital, Leeds, UK
| | | | - Sylvia Worthy
- Department of Radiology, Newcastle upon Tyne Hospital, Newcastle, UK
| | - Sisa Grubnic
- Department of Radiology, St George’s Hospital, London, UK
| | - David Burling
- Department of Radiology, St Mark’s Hospital, London, UK
| | - Clare Allen
- Department of Radiology, University College Hospital, London, UK
| | - Anwar Padhani
- Department of Radiology, Mount Vernon Cancer Centre, London, UK
| | - Brendan Carey
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Peter Cavanagh
- Department of Radiology, Musgrove Park Hospital, Taunton, UK
| | - Michael D Peake
- Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, London, UK
- Department of Surgery & Cancer, Imperial College, London, UK
| |
Collapse
|
24
|
Booth RA, McCudden CR, Balion CM, Blasutig IM, Bouhtiauy I, Rodriguez-Capote K, Catomeris P, Chan PC, Chen Y, Collier C, Hauff K, Kalra J, Li D, Lin DC, Lou AH, Meng QH, Morrison T, Pasic MD, Qureshi M, Randell E, Sohn KY, Thakur V, Thomas D, Thoni A, Tomalty C, Yang L, Zamkanei M. Candidate recommendations for protein electrophoresis reporting from the Canadian Society of Clinical Chemists Monoclonal Gammopathy Working Group. Clin Biochem 2018; 51:10-20. [DOI: 10.1016/j.clinbiochem.2017.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
|
25
|
McCudden CR, Booth RA, Lin DC, McCurdy A, Rupani N, Kew A. Synoptic reporting for protein electrophoresis and immunofixation. Clin Biochem 2018; 51:21-28. [DOI: 10.1016/j.clinbiochem.2017.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/24/2023]
|
26
|
Renshaw AA, Mena-Allauca M, Gould EW. Tabular Versus Synoptic Reporting of Prostate Core Needle Biopsies. JCO Clin Cancer Inform 2017; 1:1-7. [PMID: 30657378 DOI: 10.1200/cci.17.00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare synoptic versus tabular formats for reporting prostate core needle biopsy results. The format of a report can significantly affect the accuracy, speed, and preference with which a reader can retrieve information. METHODS We compared the performance of 20 nonpathologists in the identification of specific information in synoptic and tabular reports using a computerized quiz that measured both accuracy and speed. RESULTS Tabular formatting was significantly more accurate (97% v 93%; P = .001) and faster (mean normalized time, 0.74 + 0.40 v 0.99 + 0.52; P < .001) than synoptic formatting. The improvement in accuracy was a result of questions that involved combining results from two different biopsies (96% v 92%; P = .03). The improvement in speed was observed for both single-value questions (0.77 + 0.41 v 0.87 + 0.39; P = .03) and combination questions (0.73 + 0.40 v 1.05 + 0.56; P < .001). Data extraction from a tabular format into a structured data file using free text extraction on the basis of punctuation was 100% successful. CONCLUSION Tabular reporting of prostate needle biopsies allows significantly faster and more accurate identification of data by the user, especially when the data involve combining data from several biopsies. The tabular format does not impact the ability to create structured data files.
Collapse
Affiliation(s)
- Andrew A Renshaw
- All authors: Baptist Hospital and Miami Cancer Institute, Baptist Health of South Florida Healthcare System, Miami, FL
| | - Mercy Mena-Allauca
- All authors: Baptist Hospital and Miami Cancer Institute, Baptist Health of South Florida Healthcare System, Miami, FL
| | - Edwin W Gould
- All authors: Baptist Hospital and Miami Cancer Institute, Baptist Health of South Florida Healthcare System, Miami, FL
| |
Collapse
|
27
|
Lorimer PD, Benham EC, Walsh K, Han Y, Forster MR, Sarantou T, White RL, Hill JS. Reporting of mitotic rate in cutaneous melanoma: A study using the national cancer data base. J Surg Oncol 2017; 115:281-286. [DOI: 10.1002/jso.24503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/22/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Patrick D. Lorimer
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| | - Emily C. Benham
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| | - Kendall Walsh
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| | - Yimei Han
- Department of Biostatistics; Carolinas Healthcare System; Levine Cancer Institute; Charlotte North Carolina
| | - Meghan R. Forster
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| | - Terry Sarantou
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| | - Richard L. White
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| | - Joshua S. Hill
- Department of Surgery; Carolinas Medical Center; Levine Cancer Institute; Charlotte North Carolina
| |
Collapse
|
28
|
Renshaw MA, Renshaw SA, Mena-Allauca M, Carrion PP, Mei X, Narciandi A, Gould EW, Renshaw AA. Performance of a Web-based Method for Generating Synoptic Reports. J Pathol Inform 2017; 8:13. [PMID: 28382227 PMCID: PMC5364739 DOI: 10.4103/jpi.jpi_91_16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/22/2017] [Indexed: 12/14/2022] Open
Abstract
CONTEXT The College of American Pathologists (CAP) requires synoptic reporting of all tumor excisions. OBJECTIVE To compare the performance of different methods of generating synoptic reports. METHODS Completeness, amendment rates, rate of timely ordering of ancillary studies (KRAS in T4/N1 colon carcinoma), and structured data file extraction were compared for four different synoptic report generating methods. RESULTS Use of the printed tumor protocols directly from the CAP website had the lowest completeness (84%) and highest amendment (1.8%) rates. Reformatting these protocols was associated with higher completeness (94%, P < 0.001) and reduced amendment (1%, P = 0.20) rates. Extraction into a structured data file was successful 93% of the time. Word-based macros improved completeness (98% vs. 94%, P < 0.001) but not amendment rates (1.5%). KRAS was ordered before sign out 89% of the time. In contrast, a web-based product with a reminder flag when items were missing, an embedded flag for data extraction, and a reminder to order KRAS when appropriate resulted in improved completeness (100%, P = 0.005), amendment rates (0.3%, P = 0.03), KRAS ordering before sign out (100%, P = 0.23), and structured data extraction (100%, P < 0.001) without reducing the speed (P = 0.34) or accuracy (P = 1.00) of data extraction by the reader. CONCLUSION Completeness, amendment rates, ancillary test ordering rates, and data extraction rates vary significantly with the method used to construct the synoptic report. A web-based method compares favorably with all other methods examined and does not reduce reader usability.
Collapse
Affiliation(s)
| | | | - Mercy Mena-Allauca
- Department of Cancer Services, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami, FL, USA
| | - Patricia P. Carrion
- Department of Information Technology, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami, FL, USA
| | - Xiaorong Mei
- Department of Information Technology, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami, FL, USA
| | - Arniris Narciandi
- Department of Information Technology, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami, FL, USA
| | - Edwin W. Gould
- Department of Pathology, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami, FL, USA
| | - Andrew A. Renshaw
- Department of Pathology, Baptist Hospital and Baptist Health of South Florida Healthcare System, Miami, FL, USA
- Department of Pathology, Baptist Hospital, Miami, FL, USA
| |
Collapse
|
29
|
Brożyna AA, Guo H, Yang S, Cornelius L, Linette G, Murphy M, Sheehan C, Ross J, Slominski A, Carlson JA. TRPM1
(melastatin) expression is an independent predictor of overall survival in clinical
AJCC
stage I and
II
melanoma patients. J Cutan Pathol 2017; 44:328-337. [DOI: 10.1111/cup.12872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/11/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Anna A. Brożyna
- Department of Tumor Pathology and Pathomorphology, Oncology Centre—Prof. Franciszek Łukaszczyk Memorial Hospital, Department of Tumor Pathology and Pathomorphology, Faculty of Health SciencesNicolaus Copernicus University Collegium Medicum in Bydgoszcz Bydgoszcz Poland
| | - Huazhang Guo
- Department of PathologyUniversity of Pittsburgh Medical Center, UPMC Cancer Pavilion Pittsburgh Pennsylvania
| | - Sun‐Eun Yang
- Department of PathologyAlbany Medical College MC‐81 Albany New York
| | - Lynn Cornelius
- Division of Dermatology, Washington University School of Medicine St. Louis Missouri
| | - Gerald Linette
- Division of Oncology, Washington University School of Medicine St. Louis Missouri
| | - Michael Murphy
- Department of Dermatology, MC‐6230University of Connecticut Health Center Farmington Connecticut
| | | | - Jeffrey Ross
- Department of PathologyAlbany Medical College MC‐81 Albany New York
| | - Andrzej Slominski
- Department of DermatologyUniversity of Alabama at Birmingham Birmingham Alabama
| | | |
Collapse
|
30
|
White A, Fabian V, McDonald K, Nowak AK. Compliance with reporting guidelines by Australian pathologists: an audit of the quality of histopathology reporting in high-grade glioma. Neurooncol Pract 2016; 3:97-104. [PMID: 31386085 PMCID: PMC6668263 DOI: 10.1093/nop/npv033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diagnostic pathology reports inform management plans for patients with glioma, and there is an increasing clinical need for molecular testing. We assessed the quality of histopathology reports of grade III/IV gliomas. METHODS Reports were obtained as part of a tumor biobank. From 720 pathology reports, 594 eligible reports were assessed for 28 elements derived from published checklists. A summary quality score incorporated 9 critical parameters for clinical decision making: diagnosis using World Health Organization 2007 criteria; cell type; grade; narrative supporting cell type and grade; absence of equivocal language; conclusion reporting cell type and grade; and conclusion aligned with report narrative. RESULTS Of 594 eligible reports, the final conclusion was not supported by the report narrative in 122 (21%). Tumor classification and grade were not supported by the narrative in 105 (18%) and 36 (6%) reports, respectively. Only 145 (24%) reports fulfilled all 9 quality criteria, while 25% contained 6 or fewer key quality indices. Report quality was higher when pathologists had neuropathology subspecialization, when a grade IV tumor was reported, and when the specimen was from an initial resection or grade-progressed tumor rather than recurrent high-grade glioma. Use of molecular testing increased over time, from 29% to 48% over four quartiles of the study. Molecular testing was more frequently done where oligodendroglial elements were reported. CONCLUSION A significant proportion of reports failed to meet key indicators of report quality. Pathology reporting is critical in communicating between pathologists and treating clinicians. Clinicians should be aware of reporting quality and seek clarification when required.
Collapse
Affiliation(s)
- Alison White
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| | - Vicki Fabian
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| | - Kerrie McDonald
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| | - Anna K. Nowak
- Sir Charles Gairdner Hospital, Department of Medical Oncology,
Hospital Avenue, Nedlands,
Perth, WA 6009, Australia (A.W., A.K.N.);
Neuropathology Section, Department of Anatomical Pathology,
Pathwest, Royal Perth Hospital,
GPO Box X2213, Perth, WA 6001, Australia (V.F.);
Cure Brain Cancer Neuro-oncology Laboratory, Prince of Wales Clinical School, Lowy Cancer Research
Institute,2052UNSW Australia
(K.M., T.A.N); School of Medicine and
Pharmacology, University of Western Australia, 35 Stirling
Highway Nedlands WA 6009, Australia (A.K.N., T.A.N.)
| |
Collapse
|
31
|
The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review. Virchows Arch 2016; 468:639-49. [PMID: 27097810 PMCID: PMC4887530 DOI: 10.1007/s00428-016-1935-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/07/2023]
Abstract
Pathology reporting is evolving from a traditional narrative report to a more structured synoptic report. Narrative reporting can cause misinterpretation due to lack of information and structure. In this systematic review, we evaluate the impact of synoptic reporting on completeness of pathology reports and quality of pathology evaluation for solid tumours. Pubmed, Embase and Cochrane databases were systematically searched to identify studies describing the effect of synoptic reporting implementation on completeness of reporting and quality of pathology evaluation of solid malignant tumours. Thirty-three studies met the inclusion criteria. All studies, except one, reported an increased overall completeness of pathology reports after introduction of synoptic reporting (SR). Most frequently studied cancers were breast (n = 9) and colorectal cancer (n = 16). For breast cancer, narrative reports adequately described 'tumour type' and 'nodal status'. Synoptic reporting resulted in improved description of 'resection margins', 'DCIS size', 'location' and 'presence of calcifications'. For colorectal cancer, narrative reports adequately reported 'tumour type', 'invasion depth', 'lymph node counts' and 'nodal status'. Synoptic reporting resulted in increased reporting of 'circumferential margin', 'resection margin', 'perineural invasion' and 'lymphovascular invasion'. In addition, increased numbers of reported lymph nodes were found in synoptic reports. Narrative reports of other cancer types described the traditional parameters adequately, whereas for 'resection margins' and '(lympho)vascular/perineural invasion', implementation of synoptic reporting was necessary. Synoptic reporting results in improved reporting of clinical relevant data. Demonstration of clinical impact of this improved method of pathology reporting is required for successful introduction and implementation in daily pathology practice.
Collapse
|
32
|
King S, Dimech M, Johnstone S. Structured pathology reporting improves the macroscopic assessment of rectal tumour resection specimens. Pathology 2016; 48:349-52. [PMID: 27114373 DOI: 10.1016/j.pathol.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 01/01/2023]
Abstract
We examined whether introduction of a structured macroscopic reporting template for rectal tumour resection specimens improved the completeness and efficiency in collecting key macroscopic data elements. Fifty free text (narrative) macroscopic reports retrieved from 2012 to 2014 were compared with 50 structured macroscopic reports from 2013 to 2015, all of which were generated at John Hunter Hospital, Newcastle, NSW. The six standard macroscopic data elements examined in this study were reported in all 50 anatomical pathology reports using a structured macroscopic reporting dictation template. Free text reports demonstrated significantly impaired data collection when recording intactness of mesorectum (p<0.001), relationship to anterior peritoneal reflection (p=0.028) and distance of tumour to the non-peritonealised circumferential margin (p<0.001). The number of words used was also significantly (p<0.001) reduced using pre-formatted structured reports compared to free text reports. The introduction of a structured reporting dictation template improves data collection and may reduce the subsequent administrative burden when macroscopically evaluating rectal resections.
Collapse
Affiliation(s)
- Simon King
- Department of Anatomical Pathology, Pathology North, John Hunter Hospital, Newcastle, NSW, Australia.
| | - Margaret Dimech
- Senior Project Manager, Royal College of Pathologists of Australasia, Surry Hills, Sydney, NSW, Australia
| | - Susan Johnstone
- Department of Anatomical Pathology, Pathology North, John Hunter Hospital, Newcastle, NSW, Australia
| |
Collapse
|
33
|
Sever C, Abbott CL, de Baca ME, Khoury JD, Perkins SL, Reichard KK, Taylor A, Terebelo HR, Colasacco C, Rumble RB, Thomas NE. Bone Marrow Synoptic Reporting for Hematologic Neoplasms: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2016; 140:932-49. [PMID: 26905483 DOI: 10.5858/arpa.2015-0450-sa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -There is ample evidence from the solid tumor literature that synoptic reporting improves accuracy and completeness of relevant data. No evidence-based guidelines currently exist for synoptic reporting for bone marrow samples. OBJECTIVE -To develop evidence-based recommendations to standardize the basic components of a synoptic report template for bone marrow samples. DESIGN -The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of experts in hematopathology to develop recommendations. A systematic evidence review was conducted to address 5 key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus. RESULTS -Nine guideline statements were established to provide pathology laboratories with a framework by which to develop synoptic reporting templates for bone marrow samples. The guideline calls for specific data groups in the synoptic section of the pathology report; provides a list of evidence-based parameters for key, pertinent elements; and addresses ancillary testing. CONCLUSION -A framework for bone marrow synoptic reporting will improve completeness of the final report in a manner that is clear, succinct, and consistent among institutions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nicole E Thomas
- From the Department of Hematopathology, Pathology Associates of Albuquerque, Albuquerque, New Mexico (Dr Sever); the Department of Pathology, Berkshire Medical Center, Pittsfield, Massachusetts (Dr Abbott); Medical Laboratory Associates, Seattle, Washington (Dr de Baca); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Khoury); the Department of Pathology, University of Utah, Salt Lake City (Dr Perkins); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Dr Reichard); Utah Pathology Services, Inc, Salt Lake City (Dr Taylor); the Department of Hematology/Medical Oncology, Newland Medical Associates, Novi, Michigan (Dr Terebelo); the Departments of Governance (Ms Colasacco) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; and the Quality and Guidelines Department, American Society of Clinical Oncology, Alexandria, Virginia (Mr Rumble)
| |
Collapse
|
34
|
Compliance with the College of American Pathologists Protocol for Melanoma in Synoptic and Non-Synoptic reports: A cross-sectional study. J Am Acad Dermatol 2016; 74:179-81. [DOI: 10.1016/j.jaad.2015.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022]
|
35
|
Ellis DW, Srigley J. Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch 2015; 468:51-9. [DOI: 10.1007/s00428-015-1834-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/08/2015] [Accepted: 08/13/2015] [Indexed: 01/07/2023]
|
36
|
Smith ML, Wendel-Spiczka AJ, Zarka MA. Decreased faux addenda following standardisation of pathologist practice. J Clin Pathol 2015; 68:931-4. [DOI: 10.1136/jclinpath-2015-202931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/16/2015] [Indexed: 11/04/2022]
|
37
|
Tumino R, Minicozzi P, Frasca G, Allemani C, Crocetti E, Ferretti S, Giacomin A, Natali M, Mangone L, Falcini F, Capocaccia R, Sant M. Population-based method for investigating adherence to international recommendations for pathology reporting of primary cutaneous melanoma: Results of a EUROCARE-5 high resolution study. Cancer Epidemiol 2015; 39:424-9. [PMID: 25735220 DOI: 10.1016/j.canep.2015.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
Abstract
AIM Our study aim was to investigate the degree of adherence to international recommendations for cutaneous melanoma pathology reports at the population level by a EUROCARE high resolution study. METHODS The availability of nine characteristics - predominant cell type, tumour-infiltrating lymphocytes, mitotic index, histological subtype, growth phase, Clark level, Breslow thickness, ulceration, and sentinel-node biopsy - was examined on pathology reports of a random sample of 636 cases diagnosed in 2003-2005 in seven Italian cancer registries: Biella, Ferrara, Firenze, Latina, Ragusa, Reggio Emilia, Romagna. The odds of having (versus not having) information for all four core characteristics (last four listed above) were estimated. RESULTS Sentinel node biopsy was available most often, followed by Clark level, Breslow thickness, histological subtype and ulceration. Information on all nine characteristics was more often available in Biella and Ferrara (northern Italy) than elsewhere. Information on all four core items was available for 78% of cases. Odds of four-core-item availability were higher (than mean) in Biella and lower in Latina (centre) and Ragusa (south). CONCLUSIONS The availability of information important for staging and management was good overall on pathology reports, but varied with geography. It is likely to be improved by wider dissemination of reporting guidelines and adoption of a standardised synoptic reporting system.
Collapse
Affiliation(s)
- Rosario Tumino
- Ragusa Cancer Registry, Department of Medical Prevention, Provincial Health Unit, Ragusa, Italy; Histopathology Unit, "MP Arezzo" Civic Hospital, Ragusa, Italy.
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy.
| | - Graziella Frasca
- Ragusa Cancer Registry, Department of Medical Prevention, Provincial Health Unit, Ragusa, Italy.
| | - Claudia Allemani
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy.
| | | | - Stefano Ferretti
- Ferrara Cancer Registry, Department of Experimental and Diagnostic Medicine, Ferrara, Italy.
| | - Adriano Giacomin
- Piedmont Cancer Registry, Province of Biella (CPO), Epidemiology Unit, Biella, Italy.
| | | | - Lucia Mangone
- Statistical, Quality and Clinical Studies Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì, Italy.
| | - Riccardo Capocaccia
- National Centre for Epidemiology, Surveillance and Health Promotion, Department of Cancer Epidemiology, Istituto Superiore di Sanità, Roma, Italy.
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy.
| |
Collapse
|
38
|
Urquhart R, Porter GA, Sargeant J, Jackson L, Grunfeld E. Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting. Implement Sci 2014; 9:121. [PMID: 25224952 PMCID: PMC4173056 DOI: 10.1186/s13012-014-0121-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 08/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care. METHODS Using case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study. RESULTS The analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases. CONCLUSIONS The findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.
Collapse
Affiliation(s)
- Robin Urquhart
- />Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada
- />Cancer Outcomes Research Program, Dalhousie University/Capital Health, Halifax, Nova Scotia Canada
- />Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia Canada
- />Division of Medical Education, Dalhousie University, Halifax, Nova Scotia Canada
| | - Geoffrey A Porter
- />Department of Surgery, Dalhousie University, Halifax, Nova Scotia Canada
- />Cancer Outcomes Research Program, Dalhousie University/Capital Health, Halifax, Nova Scotia Canada
- />Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia Canada
| | - Joan Sargeant
- />Division of Medical Education, Dalhousie University, Halifax, Nova Scotia Canada
- />Continuing Professional Development, Dalhousie University, Halifax, Nova Scotia Canada
| | - Lois Jackson
- />School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia Canada
- />Atlantic Health Promotion Research Centre, Dalhousie University, Halifax, Nova Scotia Canada
| | - Eva Grunfeld
- />Ontario Institute for Cancer Research, Toronto, Ontario Canada
- />Department of Family and Community Medicine, University of Toronto, Toronto, Ontario Canada
| |
Collapse
|
39
|
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] [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.
Collapse
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
| |
Collapse
|
40
|
Niebling MG, Haydu LE, Karim RZ, Thompson JF, Scolyer RA. Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center. Ann Surg Oncol 2014; 21:2245-51. [DOI: 10.1245/s10434-014-3682-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Indexed: 12/28/2022]
|
41
|
Lam E, Vy N, Bajdik C, Strugnell SS, Walker B, Wiseman SM. Synoptic pathology reporting for thyroid cancer: a review and institutional experience. Expert Rev Anticancer Ther 2014; 13:1073-9. [PMID: 24053206 DOI: 10.1586/14737140.2013.825435] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thyroid cancer surgical pathology reports contain information that is critical for diagnosis, determining completeness of resection, staging and guiding postoperative management. Traditional narrative pathology reporting is prone to errors and omissions with variability in content and completeness. The objective of this review was to evaluate the impact of synoptic reporting on thyroid cancer pathology reporting. Our institutional study of pathology reporting of differentiated thyroid cancers at a Canadian tertiary care institution relative to the College of American Pathologists checklists is also presented and critically evaluates deficiencies in the narrative pathology reporting format.
Collapse
Affiliation(s)
- Elaine Lam
- Department of Surgery, St. Paul's Hospital, University of British Columbia, C303 - 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | | | | | | | | | | |
Collapse
|
42
|
Schatton T, Scolyer RA, Thompson JF, Mihm MC. Tumor-infiltrating lymphocytes and their significance in melanoma prognosis. Methods Mol Biol 2014; 1102:287-324. [PMID: 24258985 DOI: 10.1007/978-1-62703-727-3_16] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The role of the tumor-infiltrating lymphocyte (TIL) and its relationship to prognosis has been most extensively studied in malignant melanoma. The purpose of this chapter is to discuss in depth the immunobiology and molecular aspects of lymphocyte function in general and particularly TIL function in the context of antimelanoma immunity. Emphasis is placed upon the role of these inflammatory mediators in the enhancement and impairment of progression of this often fatal human cancer. In addition, the analysis of TILs in melanoma and their direct relationship to prognosis as well as their effect on the positivity of the sentinel lymph node will be discussed. Furthermore, details of lymph node responses to metastatic melanomas and their prognostic significance will be clarified. Finally, the importance of TILs for the evaluation of therapeutic response and how TIL immunobiology could critically inform the design of novel melanoma immunotherapeutic protocols will be elucidated.
Collapse
Affiliation(s)
- Tobias Schatton
- Department of Dermatology, Brigham and Women's Hospital and Transplantation Research Center, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | | | | | | |
Collapse
|
43
|
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] [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.
Collapse
Affiliation(s)
- Denis Chatelain
- Department of Pathology, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | | | | | | | | | | |
Collapse
|
44
|
Scolyer RA, Judge MJ, Evans A, Frishberg DP, Prieto VG, Thompson JF, Trotter MJ, Walsh MY, Walsh NMG, Ellis DW. Data set for pathology reporting of cutaneous invasive melanoma: recommendations from the international collaboration on cancer reporting (ICCR). Am J Surg Pathol 2013; 37:1797-814. [PMID: 24061524 PMCID: PMC3864181 DOI: 10.1097/pas.0b013e31829d7f35] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An accurate and complete pathology report is critical for the optimal management of cutaneous melanoma patients. Protocols for the pathologic reporting of melanoma have been independently developed by the Royal College of Pathologists of Australasia (RCPA), Royal College of Pathologists (United Kingdom) (RCPath), and College of American Pathologists (CAP). In this study, data sets, checklists, and structured reporting protocols for pathologic examination and reporting of cutaneous melanoma were analyzed by an international panel of melanoma pathologists and clinicians with the aim of developing a common, internationally agreed upon, evidence-based data set. The International Collaboration on Cancer Reporting cutaneous melanoma expert review panel analyzed the existing RCPA, RCPath, and CAP data sets to develop a protocol containing "required" (mandatory/core) and "recommended" (nonmandatory/noncore) elements. Required elements were defined as those that had agreed evidentiary support at National Health and Medical Research Council level III-2 level of evidence or above and that were unanimously agreed upon by the review panel to be essential for the clinical management, staging, or assessment of the prognosis of melanoma or fundamental for pathologic diagnosis. Recommended elements were those considered to be clinically important and recommended for good practice but with lesser degrees of supportive evidence. Sixteen core/required data elements for cutaneous melanoma pathology reports were defined (with an additional 4 core/required elements for specimens received with lymph nodes). Eighteen additional data elements with a lesser level of evidentiary support were included in the recommended data set. Consensus response values (permitted responses) were formulated for each data item. Development and agreement of this evidence-based protocol at an international level was accomplished in a timely and efficient manner, and the processes described herein may facilitate the development of protocols for other tumor types. Widespread utilization of an internationally agreed upon, structured pathology data set for melanoma will lead not only to improved patient management but is a prerequisite for research and for international benchmarking in health care.
Collapse
Affiliation(s)
- Richard A Scolyer
- *Melanoma Institute Australia Disciplines of †Pathology **Surgery, Sydney Medical School, The University of Sydney Departments of ‡Tissue Pathology and Diagnostic Oncology ††Melanoma and Surgical Oncology, Royal Prince Alfred Hospital §Royal College of Pathologists of Australasia, Sydney, NSW ¶¶Royal Adelaide Hospital and Flinders University, Adelaide, SA, Australia ∥Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland ¶Cedars-Sinai Medical Center, Los Angeles, CA #Departments of Pathology and Dermatology, University of Texas-MD Anderson Cancer Center, Houston, TX ‡‡Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB ∥∥Department of Pathology, Capital District Health Authority and Dalhousie University, Halifax, NS, Canada §§Royal Victoria Hospital, Belfast, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Niebling MG, Haydu LE, Karim RZ, Thompson JF, Scolyer RA. Reproducibility of AJCC staging parameters in primary cutaneous melanoma: an analysis of 4,924 cases. Ann Surg Oncol 2013; 20:3969-75. [PMID: 23851608 DOI: 10.1245/s10434-013-3092-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathology reports are of critical importance for conveying information to clinicians who must make important management decisions for their patients. This study sought to assess and compare the precision, reproducibility, and completeness of external pathology reports and pathology reports generated by central review of each case in a large cohort of primary cutaneous melanoma patients. METHODS Details of matched external pathology reports and corresponding review reports for 4,924 primary cutaneous invasive melanomas diagnosed and treated at Melanoma Institute Australia (MIA) between 2001 and 2011 were analyzed. RESULTS Interobserver agreement was excellent for American Joint Committee on Cancer (AJCC) T staging parameters: Breslow thickness (intraclass correlation coefficient [ICC] 0.984), mitotic rate (ICC 0.833), and ulceration (kappa statistic [κ] 0.823). All three of these important pathologic variables were included in 92.4 and 66.9% of review (MIA) and external (non-MIA) pathology reports, respectively. Completeness of MIA and non-MIA pathology reports for the three essential T-staging criteria increased significantly from 87.9 to 94.6% (χ(2) = 9.1, df = 1, P = 0.003) and from 53.2 to 74.3% (χ(2) = 35.0, df = 1, P < 0.001) over the 10-year study period. The AJCC N staging parameter of microsatellites was recorded in only 43% of non-MIA reports and demonstrated moderate concordance (κ = 0.560). CONCLUSIONS Reproducibility and completeness of pathology reports for many important histopathologic features have improved in recent years. Nevertheless, the documentation of microsatellites remained poor in external pathology reports. To enhance the usefulness of the pathology report for the provision of optimal melanoma patient care, continued efforts to encourage pathologists to document its key features appear warranted.
Collapse
|
46
|
Srigley J, Lankshear S, Brierley J, McGowan T, Divaris D, Yurcan M, Rossi R, Yardley T, King MJ, Ross J, Irish J, McLeod R, Sawka C. Closing the quality loop: facilitating improvement in oncology practice through timely access to clinical performance indicators. J Oncol Pract 2013; 9:e255-61. [PMID: 23943888 DOI: 10.1200/jop.2012.000818] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Health care organizations and professionals are being called on to develop clear and transparent measures of quality and to demonstrate the application of the data to performance improvement at the system and provider levels. MATERIALS AND METHODS Cancer Care Ontario (CCO) initiated a pathology reporting project aimed at improving the quality of cancer pathology by standardizing the content, format, and transmission of reports to a central registry and enabling the information to be available for planning, quality measurement, and quality improvement. This population-based quality-improvement project involved more than 400 Ontario pathologists and more than 100 hospitals. Clinically relevant quality indicators that used the newly available data were developed and shared. Synoptic pathology data were electronically captured at the point of report development and used to automate the timely generation of clinical performance indicators that support quality improvement in surgical oncology. These reports provided comparison data at the organizational, regional, and population levels. RESULTS Monthly quality indicator reports are generated and distributed to each cancer center and are used to generate dialogue at the professional, organizational, and regional levels regarding evidence-informed quality-improvement opportunities. Since the launch of the project, colorectal lymph node retrieval rates have increased from 76% to 87%, and pT2 prostatectomy margin positivity rates have decreased from 37% to 21%. CONCLUSION High-quality, complete cancer pathology reports are important not only for contemporary oncological practice, but also for secondary users of pathology information including tumor registries, health planners, epidemiologists, and others involved in quality-improvement activities and research.
Collapse
Affiliation(s)
- John Srigley
- Cancer Care Ontario; University Health Network; Mount Sinai Hosptial; University of Toronto, Toronto; Trillium Health Partners, Mississauga; Grand River Hospital, Kitchener; and McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Lankshear S, Srigley J, McGowan T, Yurcan M, Sawka C. Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists. Arch Pathol Lab Med 2013; 137:1599-602. [DOI: 10.5858/arpa.2012-0656-oa] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time.
Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process.
Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments.
Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P < .001) and ease of finding information for clinical decision making (r = 0.663, P < .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion.
Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.
Collapse
Affiliation(s)
- Sara Lankshear
- From the Cancer Information Program (Dr Lankshear and Ms Yurcan), the Programs of Laboratory Medicine (Dr Srigley) and Oncology (Dr McGowan), Trillium Health Partners, Mississauga, Ontario Canada, and Clinical Programs and Quality Initiatives (Dr Sawka)
| | - John Srigley
- From the Cancer Information Program (Dr Lankshear and Ms Yurcan), the Programs of Laboratory Medicine (Dr Srigley) and Oncology (Dr McGowan), Trillium Health Partners, Mississauga, Ontario Canada, and Clinical Programs and Quality Initiatives (Dr Sawka)
| | - Thomas McGowan
- From the Cancer Information Program (Dr Lankshear and Ms Yurcan), the Programs of Laboratory Medicine (Dr Srigley) and Oncology (Dr McGowan), Trillium Health Partners, Mississauga, Ontario Canada, and Clinical Programs and Quality Initiatives (Dr Sawka)
| | - Marta Yurcan
- From the Cancer Information Program (Dr Lankshear and Ms Yurcan), the Programs of Laboratory Medicine (Dr Srigley) and Oncology (Dr McGowan), Trillium Health Partners, Mississauga, Ontario Canada, and Clinical Programs and Quality Initiatives (Dr Sawka)
| | - Carol Sawka
- From the Cancer Information Program (Dr Lankshear and Ms Yurcan), the Programs of Laboratory Medicine (Dr Srigley) and Oncology (Dr McGowan), Trillium Health Partners, Mississauga, Ontario Canada, and Clinical Programs and Quality Initiatives (Dr Sawka)
| |
Collapse
|
49
|
Urquhart R, Sargeant J, Grunfeld E. Exploring the usefulness of two conceptual frameworks for understanding how organizational factors influence innovation implementation in cancer care. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2013; 33:48-58. [PMID: 23512560 DOI: 10.1002/chp.21165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Moving knowledge into practice and the implementation of innovations in health care remain significant challenges. Few researchers adequately address the influence of organizations on the implementation of innovations in health care. The aims of this article are to (1) present 2 conceptual frameworks for understanding the organizational factors important to the successful implementation of innovations in health care settings; (2) discuss each in relation to the literature; and (3) briefly demonstrate how each may be applied to 3 initiatives involving the implementation of a specific innovation-synoptic reporting tools-in cancer care. Synoptic reporting tools capture information from diagnostic tests, surgeries, and pathology examinations in a standardized, structured manner and contain only the information necessary for patient care. The frameworks selected were the Promoting Action on Research Implementation in Health Services framework and an organizational framework of innovation implementation; these frameworks arise from different disciplines (nursing and management, respectively). The constructs from each framework are examined in relation to the literature, with each construct applied to synoptic reporting tool implementation to demonstrate how each may be used to inform both practice and research in this area. By improving our understanding of existing frameworks, we enhance our ability to more effectively study and target implementation processes.
Collapse
Affiliation(s)
- Robin Urquhart
- Knowledge Broker, Cancer Outcomes Research Program, Cancer Care Nova Scotia, and Interdisciplinary PhD Program, Dalhousie University, Halifax, NS B3H 2Y9.
| | | | | |
Collapse
|
50
|
Al-Sukhni E, Messenger DE, Charles Victor J, McLeod RS, Kennedy ED. Do MRI reports contain adequate preoperative staging information for end users to make appropriate treatment decisions for rectal cancer? Ann Surg Oncol 2012; 20:1148-55. [PMID: 23143592 DOI: 10.1245/s10434-012-2738-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Indexed: 12/16/2022]
Abstract
PURPOSE This study was designed to elicit end-user opinions regarding the importance and diagnostic accuracy of MRI for T-category, threatened or involved circumferential margin (CRMi), and lymph node involvement (LNi) for preoperative staging of rectal cancer and to determine completeness of MRI reports for these elements on a population based level. METHODS The first part of this study was a mailed survey of surgeons, radiation oncologists, and medical oncologists to elicit their opinions regarding the importance and diagnostic accuracy of T-category, CRMi, and LNi on MRI. The second part of the study was an audit of MRI reports issued for pre-operative staging of rectal cancer to assess the completeness of these reports for T-category, CRMi, and LNi. RESULTS Although T-category, CRMi, and LNi were considered essential by 97, 94, and 77 % of respondents, respectively, the MRI report audit showed that only 40 % of MRI reports captured all of these elements. The majority of end users reported moderate diagnostic accuracy on MRI for T-category and CRMi and low diagnostic accuracy for LNi (52.3, 43, and 48.5 % respectively). Multivariate analysis showed that specialty was the only independent predictor of correct reporting of the diagnostic accuracy for each of the MRI elements. CONCLUSIONS While end users consider T-category, CRMi and LNi essential for preoperative staging of rectal cancer, less than 40 % of MRI reports captured all of these elements. Therefore, strategies to improve communication between radiologists and end users are critical to improve the overall quality of care for rectal cancer patients.
Collapse
Affiliation(s)
- Eisar Al-Sukhni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | | | | |
Collapse
|