Introduction
Accurate, consistent reporting of surgical specimens is vital to guide clinical decisions in breast cancer management. In 2017, NHS England consolidated pathology services with hub and spoke networks which aimed to improve efficiency and reduce variation. Following a Serious Incident Requiring Investigation within our well-performing breast unit, it became clear that standardised reporting improves patient safety. An audit was conducted to assess reporting consistency.
Methods
The Royal College of Pathologists (RCPath) guideline ‘Pathology reporting of breast disease in surgical excision specimens’ describes a dataset that 90% of reports should include. We reviewed reports from October–December 2021 at one unit (reference SSM22001), analysing the reports for inclusion of guideline components. Margin and lymph node re-excisions were excluded. In the second audit cycle, we introduced a reporting proforma based on RCPath guidelines and re-audited cases from October–December 2023.
Results
In the first cycle, 65 of 126 reports were analysed (65% wide local excision, 35% mastectomy). While specimen type, histological grade, and presence of invasive disease were consistently reported, others were not: date of surgery (0%), necrosis (15.2%), microinvasion (4.3%). In the second cycle (39 reports), documentation improved: necrosis (87.5%), microinvasion (25.6%), though date of surgery remained absent.
Conclusions
Significant variation existed in pathology reporting. As multi-disciplinary team decisions rely on these reports, errors could arise if components are omitted or incomplete when reports are published. Incident investigations prompt change and enhance patient safety. We proposed implementation of a streamlined proforma aligned with RCPath guidelines which significantly improved reporting standards.
Authors
Olivia Szepietowski
Ashford + St Peter's Hospitals Trust, Surrey, United Kingdom
Eve Cramp
Ashford + St Peter's Hospitals Trust, Surrey, United Kingdom
Jade Davies
Ashford + St Peter's Hospitals Trust, Surrey, United Kingdom