Adequacy of histopathology reports for breast cancer in New South Wales

To assess the adequacy of diagnostic histopathology reports for breast cancer in New South Wales (NSW) and the Australian Capital Territory (ACT), a cross-sectional survey of diagnostic histopathology reports was carried out on a random sample (n = 1000) of NSW and ACT women diagnosed with breast cancer in 1992 and notified to the NSW Central Cancer Registry. A single pathologist with expertise in breast cancer reviewed the reports, from laboratories in public and private sectors, against a checklist enumerating basic features considered useful for decision making by surgeons and/or medical and radiation oncologists. While information was provided by almost all reports on histological classification (94%), size of tumor (93%) and involvement of lymph nodes (99.8%), this was not so for tumor resection/biopsy margin (77%), histological grade (69%), nuclear grade (23%), mitotic rate (11%) and the presence or absence of lymphatic (34%) or vascular (24%) invasion. Pathologists from teaching hospitals and those who reported on more than 10 cases in the sample were more likely to provide relevant information. Many diagnostic histopathology reports for breast cancer did not fulfil the requirements for a satisfactory report, established prognostic and predictive features frequently being omitted. The uniform use by pathologists of a carefully designed checklist could ensure that standard information is provided for every breast cancer, thereby facilitating choice of therapy for all patients.