Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Criteria For A Breast Cancer Pathology Report
      

There are situational factors, pathologist factors, and referring physician factors which might combine in a wide variety of ways to result in a combination of factors which reasonably allow for only a certain regular presentation of data within a pathology report.  If the payment system (managed care, indigent load, Medicare, Medicaid) in an area pays low to physicians and hospitals, there may be a severe clericalsystem limitation.  If a hospital is otherwise underfunded and is unable to employ sufficiently trained workers or pathologists in adequate numbers, then there is a severe provider system limitation.  If pathology is done remotely and not at "point of service", there are potentially severe quality & accountability limitations.  For hospital-based pathologists, the mission of the hospital (commercial, government owned, corporate, or wealthy private) is a major influence on what is possible by virtue of differences in allocation of resources and differences as to what the mission ultimately serves (the best interest of patients, the desires for control, and/or financial aspirations). 

Fate or actual strategy may result in the pathology coverage within the hospital being provided by various types of pathologists with various professional missions.  Finally, the clinical physicians may exert a greater or lesser influence on what is desired (it could be that very few are particularly interested in breast cancer or a large number are interested, even expert, in breast cancer) in pathology reports. Multidisciplinary conferences help communicate desires, which we pathologists must discern. So, a multidisciplinary conference not only helps in specific case decision making, the "drift" that the pathologists discern from the discussions have the potential for influencing the content and arrangement of the pathology report. The surgical pathology lab is not a manufacturing system that produces 10 widgets per hour with exactly similar features just because a manager says so.

 The above having been said, we must abide by a fundamental rule: "first do no harm".  Pathologists need to be careful that they do not include erroneous or too-distracting information in a report.  By way of clinical information recapitulated into the report or by the pathologists own studies, serious attempts must be made to accurately diagnose benign from malignant, carcinoma  vs. other malignancies, to determine the size and grade of the tumor, and to determine adequacy of surgical margins. These are crucial bits of information which require significant attention to detail in order to render these factors correctly.  All are sometimes amazingly difficult to discern accurately.  Reporting of more "modern" information parameters should come AFTER the exacting reporting of fundamental parameters. This is similarly true for all other specimen types. And, it is wise to refrain from straining or stretching to hard to have a succinct report with highly specific and definitive diagnosis. Stay adequately generic in the final diagnosis and refer to a brief & pertinent differential diagnosis (DDX) paragraph for review of what's being considered & what is most favored, etc.  

 Standard operating procedures or accreditation standards can "command" that pathology reports contain all sorts of information.  But, is that commanded information completed with "care" or just rendered in order to complete a case report "by the rules"?  But, it is the combined attitudes (expressed most specifically by the pathologists) that are fostered by strong leadership that result in pertinent and valuable accuracy of any and all factors, under a given set of circumstances.

 

Our pathology group approaches Anatomic Pathology from the conviction that patients tend now to be much more involved in their care decisions than ever before.  And, therefore, they are being given copies of pathology reports (not just breast cancer reports) which they then share with friends or family members elsewhere in the USA or around the world who may be able to give additional advice or direction or support.  Therefore, our reports should keep the informed laymen in mind.  Our reports contain our website URL, and the website contains explanatory information.  In view of all of this, we try to inject all pertinent clinical detail into our reports, very specific gross-examination-of-the-specimen detail, and then very specific quantitative and qualitative descriptive histological, cytological, and special stain detail into the "microscopic" portion of the report.  We also use the report to "teach".  Some of us use various gross and microscopic templates to help assure that such detail is addressed precisely, case after case.  

 Diagnostic templates are constructed according to the information of current importance as discerned at our weekly multi-disciplinary conference meetings.  Other information which may be important tends to be documented in the microscopic section of the report. We want our report to be as valuable as possible! I (EBS), for example, have about a dozen different templates related to breast cancer cases.

[extended commentary]

 

[posted 11 May 2005; latest addition 7 January 2008]

 
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