Standardisation of breast cancer pathology report. Gerd JACOMEN Pathology Breast Clinic AZ St Maarten Duffel/Mechelen Breast Clinic Voorkempen Malle
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1 Standardisation of breast cancer pathology report Gerd JACOMEN Pathology Breast Clinic AZ St Maarten Duffel/Mechelen Breast Clinic Voorkempen Malle
2 Reporting BreastCa Pathology report = important tool Way of communication between pathologist and clinician Needed for treatment decisions Needed for cancer registration Should be clear and structured, complete and concise
3 Optimalisation = joint effort VVOG invited their pathologists with interest in breast pathology Liesbeth Vaneyken (Belgian Cancer Registry) No official mandate Only Flemish pathologists Only gynaecologists and pathologists
4 Participants Gynaecologists Pathologists Patrick Berteloot (Duffel) Jan Decloedt (Dendermonde) Liesbeth Bekaert/Joke Van Aken (Ghent) Carine De Rop (Bonheiden) Cecile Colpaert (Antwerp) Patrick Neven (Leuven) Guy Oreye (Hasselt) Gracienne Staelens (Kortrijk) Chris Vereecke (Ghent) Ria Drijkoningen (Hasselt) Romaric Croes (Dendermonde) Gerd Jacomen (Duffel) Kathleen Lambein (Ghent) Philippe Moerman (Leuven) Erwin Pierre (Bonheiden) Anne-Marie Schelfhout (Aalst) Heidi Woestenborghs (St Niklaas)
5 Participants Gynaecologists Pathologists Patrick Berteloot (Duffel) Jan Decloedt (Dendermonde) Liesbeth Bekaert/Joke Van Aken (Ghent) Carine De Rop (Bonheiden) Cecile Colpaert (Antwerp) Patrick Neven (Leuven) Guy Oreye (Hasselt) Gracienne Staelens (Kortrijk) Chris Vereecke (Ghent) Ria Drijkoningen (Hasselt) Romaric Croes (Dendermonde) Gerd Jacomen (Duffel) Kathleen Lambein (Ghent) Philippe Moerman (Leuven) Erwin Pierre (Bonheiden) Anne-Marie Schelfhout (Aalst) Heidi Woestenborghs (St Niklaas)
6 Participants Gynaecologists Pathologists Patrick Berteloot (Duffel) Jan Decloedt (Dendermonde) Liesbeth Bekaert/Joke Van Aken (Ghent) Carine De Rop (Bonheiden) Cecile Colpaert (Antwerp) Patrick Neven (Leuven) Gracienne Staelens (Kortrijk) Chris Vereecke (Ghent) Ria Drijkoningen (Hasselt) Romaric Croes (Dendermonde) Gerd Jacomen (Duffel) Kathleen Lambein (Ghent) Philippe Moerman (Leuven) Erwin Pierre (Bonheiden) Anne-Marie Schelfhout (Aalst) Heidi Woestenborghs (St Niklaas)
7 Optimalisation on 2 fronts Standardisation of request form Generating minimal requirements for pathology report Only content Not format
8
9 Fixation 1. Type 2. Duration 3. Delay
10 Type of fixation Is fresh tissue indicated? Neutral buffered formalin Use of a fixative other than what is used in routine in your team can affect result of IHC,... Check with your pathologist!!! Specify on request form!!!
11 Ideal 6-48 Hrs Duration of fixation Prolonged fixation: weekend Rarely a problem HER-2 IHC is not affected by extended fixation up to 120 Hrs Ibarra (Am J Clin Pathol oct 2010) Minimal fixation: rapid turnaround times
12 Duration of fixation Tumour has to be fixed for at least 6 Hrs Shorter: ER CNB also needs 6 Hrs! Minimum Formalin Fixation Time for Consistent Estrogen Receptor Immunohistochemical Staining of Invasive Breast Carcinoma Goldstein NS, Am J Clin Pathol 2003
13 Consequence Tissue obtained after Hr may not be processed the same day If processed same day: neg/low ER is not conclusive
14 Is 6 Hrs sufficient? Formalin: few mm/hr Tumour 1 cm from section margin: fixation starts after 5 hours!!! Immediate incision is necessary
15 How to report fixation time? Unknown < 6 Hrs 6-48 Hrs > 48 Hrs
16 Delay of fixation ER begins to diminish with delay to fixation of 2Hrs PgR 1 Hr HER2 ISH begins after 1 Hr, significant after 2 Hrs Khoury T, Mod Pathol 2009
17 How to report delay of fixation? Unknown < 1Hr 1-2 Hrs > 2 Hrs
18 Standardising the report Only content Minimal!!! All participants report more Not format Would be ideal for registration Knowledge of ID-systems required Leaves room for more than minimalistic approach
19 What should be in report? Number of tumours Localisation Largest diameter Distance to nearest section margin Which section margin?
20 Characteristics of tumour Type (WHO 2003) Grade (Nottingham, Ellis & Elston) Optional: mitotic activity Lymphovascular invasion
21 Prognostic and predictive markers ER PgR Allred score: % and intensity HER2 IHC USCAP guidelines HER2 ISH Amplification or not HER2/CEP17 Cave amplification of HER2 and CEP17!!
22 Associated lesions DCIS Diameter of WHOLE lesion Distance to section margin (which?) Nuclear grade (according to ECWGBSP) LCIS Morbus Paget of the nipple
23 Pure DCIS Diameter Distance to section margin (which?) Nuclear grade (according to ECWGBSP) Optional: Van Nuys Prognostic Index Optional: architectural pattern ER, PgR: % positive nuclei
24 Lymph nodes Total number Number of LN with metastasis Largest diameter Number of LN with extracapsular invasion
25 Sentinel nodes Total number Number of LN with metastasis Largest diameter Number of LN with extracapsular invasion
26 TNM ptn(m): 7th edition Is missing in 50%!!!
27 Was it necessary? International guidelines do exist Eusoma, UK, USCAP, NPAV Reports are not always complete (L. Van Eyken) VVOG also felt the need
28 Submitted Bel J Med Oncol Standardisation of the breast pathology request form and the breast pathology report: a proposal by the VVOG, BIG Senologie. Cecile Colpaert, Gracienne Staelens, Gerd Jacomen, Patrick Neven and Philippe Moerman on behalf of the BIG Senologie of the VVOG (subgroup with special interest in breast pathology of the Flemish Society of Obstetrics and Gynaecology)
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