Breast Cancer Pathology Reporting in a LMIC: Filling in the Gaps

Abstract

Background: Breast cancer biology has been studied extensively over the past 5 decades, with a deeper understanding of the epidemiologic, clinical, and prognostic value of specific pathologic features. Tumor characterization beyond histologic type has been shown to guide treatment choices and ultimately improve outcomes. Pathologic features such as tumor grade, margin involvement, hormone and growth factor receptor overexpression, are all pieces of the puzzle that a clinician must put together to adequately map out the best treatment options available to the present-day breast cancer patient. Guidelines for breast cancer pathology reporting have been published, with universal consensus regarding the basic elements required to make a breast cancer pathology report complete. Aim: The aim of this study was to assess the completeness of pathology reports of breast cancer patients at all stages of diagnosis or treatment, presenting in an oncology department of a Nigerian teaching hospital over the period of one year. Methods: Pathology reports of 981 breast cancer patients attending the oncology clinic in 2016 were analyzed. Reports originated both from within the teaching hospital and from external pathology centers all over the country. Eight parameters were selected to analyze completeness of the reports: Specimen type, histologic type, immunohistochemistry, margin involvement, lymphovascular space invasion, pathologic stage, and tumor grade. Results: Of 981 pathology reports analyzed, 20.9% originated from the hospitals' pathology department. Specimen type was documented in 86% of reports. 24% of did not specify the histologic type, and almost half (44%) of reports did not specify the grade. 72% of the pathology reports did not have immunohistochemistry results ( Fig 1 ). Presence or absence of lymphovascular space invasion was reported in 10%; margin status in 32.3% ( Fig 2 ). Tumor stage was documented in 45%. Ki-67 was not reported in 99% of the pathology reports (Fig 3). Conclusion: Breast cancer survival has improved significantly globally; however LMICs such as Nigeria continue to lag behind. The reasons for this are undoubtedly multifactorial, however inadequate pathology reporting is worth exploring in the context of assessing the consequences of clinicians making decisions, armed with limited information regarding the biology of the tumor they are treating. In general, reports originating from within the hospital's pathology department were more complete than those from referring centers, with up to 7 out of 8 parameters present in at least 50%. Pathology reporting of breast cancer must be standardized in LMICs. Hundreds of years after Cheatle and Cutler first published their pathologic findings from breast cancer specimens; clinicians should no longer be subjected to the practice of making treatment decisions using inadequate data. Perhaps this will bring us one small step closer to achieving survival rates comparable to the rest of the world.[Figure: see text]