Pathology Report

Interpretation

By

Osama El-Zaafarany

Aim:

Good communication and transfer of information between the pathologist and the oncologist.

To interpret the items and terms in pathology report to clinical data and appropriate treatment decisions.

Contents:

1) Definition of pathology report.

2) Introduction.

3) Items of pathology report. (according to NCI)

4) Examples of pathology reports.

5) Clinical significance of pathology report items.

1) Definition of pathology report.

2) Introduction.

3) Items of pathology report. (according to NCI)

4) Examples of pathology reports.

5) Clinical significance of pathology report items.

What is pathology report?

A pathology report is a document that contains the diagnosis determined by examining cells and tissues under a microscope.

Created by a pathologist; who is a doctor who does this examination and writes the pathology report.

(According to National Cancer Institute.)

1) Definition of pathology report.

2) Introduction.

3) Items of pathology report. (according to NCI)

4) Examples of pathology reports.

5) Clinical significance of pathology report items.

Introduction Eighty-two million surgical pathology and cytology reports were issued in the United States during 2007, a subset of these reports will be misunderstood by readers. Recent attention has focused on standardizing the content of pathology reports, particularly for common malignancies, to facilitate transmission of required information.

ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــArch Pathol Lab Med. 2008; 132: 84–94

In the early 1990s, a number of pathology professional societies began issuing recommendations; variously called guidelines, protocols, templates, practice parameters, or checklists. Specifying a minimum Set of data elements that should be included in pathology reports for particular tissue types or pathologic diagnoses.

In 2004, the American College of Surgeons’ Commission on Cancer required as a condition of cancer program accreditation that surgical pathology cancer reports conform to the College of American Pathologists (CAP) Cancer reporting protocols

Several multi-institutional studies of pathology reports

have demonstrated gaps between data elements recommended for inclusion in reports and the elements actually included.

For example, in a review of 7300 pathology biopsy reports on mammographically detected breast lesions only 62% of reports correlated the mammographic abnormality with the microscopic findings.

In only 92% of malignant cases was

the margin status reported, and only

77% of reports specified the lesion size.

ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــNakhleh RE, Jones B, Zarbo RJ. Mammographically directed breast biopsies:

A College of American Pathologists Q-Probes study of clinical physician expectations and of specimen handling and reporting characteristics in 434 institutions.

Arch Pathol Lab Med. 1997; 121: 11–18

The CAP has developed a list of specific features that define synoptic reporting formatting:

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1) Definition of pathology report.

2) Introduction.

3) Items of pathology report. (according to NCI)

4) Examples of pathology reports.

5) Clinical significance of pathology report items.

What information does a pathology report usually include?

o Patient information: Name, birth date,

biopsy date, procedure.

oGross description: type, Color, weight, and size of tissue as seen by the naked eye

oMicroscopic description:

How the sample looks

under the microscope

and how it compares

with normal cells

oDiagnosis:

Type of tumor/cancer

More information which may guide the treatment line for the patient (risk factors):

- grade.

- lymphovascular invasion.

- perineural invasion.

- margin invasion.

- LNs infilteration.

oOther tests: immunuhisto-chemistery (e.g: CDs), molecular diagnostic and cytogenetic studies.

o Pathologist’s signature and name and address of the laboratory.

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Arch Pathol Lab Med. 2008; 132: 84–94

1) Definition of pathology report.

2) Introduction.

3) Items of pathology report. (according to NCI)

4) Examples of pathology reports.

5) Clinical significance of pathology report items.

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http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition_and_examples.pdf

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http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition_and _examples.pdf

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http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/synoptic_report_definition_and_examples.pdf

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Arch Pathol Lab Med. 2008; 132: 84–94

1) Definition of pathology report.

2) Introduction.

3) Items of pathology report. (according to NCI)

4) Examples of pathology reports.

5) Clinical significance of pathology report items.

Important notes for oncologists: (1) Gross description:

Tumor size: Impact on treatment decision e.g breast cancer if the mass > 1 cm, this patient should receive chemo.

Capsule: in some ovarian tumors if it ruptures it will increases risk of recurrence.

Number of the masses: multifocality & multicentericity.

Necrosis: aggressive tumor, rapid growth.

Number of Lymphnodes: indicates appropriate surgical dissection e.g breast cancer, cancer colon and impact treatment decision.

(2) Microscopic description

Type of tumor: Breast cancer:

ILC: bilaterality

Medullary carc. : good prognosis.

Shape of the cells: Lymphoma: large cells.

Small round cells: guide further investigations.

Signet ring: poor prognosis.

Configuration & arrangement of the cells: Lymphoma: diffuse, follicular.

Background: Hodgkin lymphoma: increase no. of lymphocytes may indicate good prognosis.

Grade:

Breast cancer: prognostic factor and guide the treatment decision (need for adjuvant chemotherapy).

Soft tissue sarcoma: high grade tumors needs adjuvant chemo.

Lympho-vascular invasion: Risk factor in breast carcinoma and guide treatment decision.

peri-neural invasion: Risk factor in head and neck squamous cell carcinoma, and guide the use of adjuvant radiotherapy.

Margin status: In soft tissue sarcoma, if positive the treatment decision may be surgical re-excision or radiotherapy. Also in breast conservative surgery it is very important. And in head and neck cancers; positive and close margins indicate the need for adjuvant radiotherapy. In some cancers it is important to know the free margins in centimeters, as in melanoma.

Lymphnodes infilteration: Infilterated or not: in cancer colon it raised the stage from II to III and mandate the use of adjuvant chemotherapy.

Number of infilterated LNs: in breast cancer in guide the treatment plan; use of adjuvant radiotherapy and type of chemo. (Taxanes).

The method of writing pathology reports should be

standardized to facilitate information transmission

between pathologists and oncologists, which will

optimize patient care.

This could be achieved by following the CAP

protocols.

The oncologists should be trained on how to interpret

pathology reports.