Histopathology reporting of breast cancer in Queensland: the impact on the quality of reporting as a result of the introduction of recommendations

Aims: Recommendations for the pathology reporting ofbreast cancer were released in Australia to ensure detailedcommunication of important prognostic features and goodpatient management. An audit of the reporting of invasivebreast cancer in Queensland was conducted to determinehow well these guidelines were utilised in 2004.Methods: A random sample of reports was audited forinclusion of recommended criteria. The proportion of reportsmeeting each of the criteria was determined and comparedacross whether the report was in a synoptic report templateor in a free text format. Comparison was made with publisheddata from prior to the release of the recommendations.Results: Of the 419 reports in the sample, at least 90% ofreports included lesion size, histological type, histologicalgrade, lymph node involvement, margins of excision,lymphovascular invasion, and changes in adjacent breasttissue individually, and 74% included all seven of theseessential criteria. Synoptic reports accounted for 76% of thesample and were significantly more likely to have documentedgrade (p50.001), quadrant (p¼0.003), calcification(p50.001), lymphovascular invasion (p50.001), changesin non-neoplastic breast (p50.001) and ductal carcinomain situ criteria (p50.001) compared with free text reportformat. The most notable improvements since the implementationof the recommendations were in documentation ofadjacent breast tissue (92% versus 49%) and lymphovascularinvasion (97% versus 54%).Conclusion: Breast cancer reporting in Queensland hasimproved since the implementation of the recommendations,however further improvements would likely be seen if there ismore widespread utilisation of a synoptic report format.