在基于人群的外阴癌患者队列中研究病理报告的完整性和病理回顾的意义

　　Completeness of pathology reporting and impact of pathology review in population- based cohort of vulvar cancer patients

　　L. Barbera¹, L.T. Gien², G. Thomas¹, A. Covens², L. Elit³, A. Fyles⁴, E. Rakovitch¹, Y. Liu⁵, M. Khalifa⁶

　　¹Department of Radiation Oncology, ²Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ³Division of Gynecologic Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ⁴Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, ⁵Institute for Clinical Evaluative Sciences, ⁶Department of Pathology, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada

　　Objectives: To describe the completeness of pathology reporting by specialist or general pathologists and the impact of a pathology review in a population-based cohort of vulvar cancer patients.

　　Methods: All cases of vulvar carcinoma diagnosed between 1998 and 2007 were identified using the provincial cancer registry. All pathology reports available from the registry for this cohort were abstracted for tumor details and prognostic factors. This analysis excludes groin specimens. Vulva specimens greater than 1.5cm were labeled “resections,” those smaller were labeled biopsies. Factors assessed for completeness of reporting were grade, size, depth, thickness, lympho-vascular space invasion (LVI), peripheral margin and deep margin.

　　Results: We identified 1,254 patients using electronic registry records. Preliminary analysis indicates 840 reports that fell into our definition of vulva resections: 534 from gyne-pathologists, 306 from general pathologists. The percentage of reports with at least one variable missing was 16% for gyne-pathologists and 45% for general pathologists. Depth of invasion was missing in 30% and 57% of reports for gyne and general pathologists respectively. 155 reports of a biopsy or resection reported by a general pathologist had a review of the same specimen by a gyne-pathologist. 133 (86%) reports had a discrepancy on at least one factor. 50 (32%) reports changed from depth missing or < 1mm to being documented or increased depth of invasion.

　　Conclusions: Missing data was commonly found in reports from general and gyne-pathologists. Pathology reviews changed important results in 86% of cases. This has important implications for treatment decision-making.

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