Pathology Request Research Articles

FP4.6 - A Re-audit on the completion of pathology request forms following Colorectal Cancer Resection

Abstract Aim Good Histopathology is key to accurate staging for Colorectal cancer. The Royal College of Pathologists have outlined a number of important parameters to detail on the pathology request form following colorectal cancer resection surgery including confirmation of specimen, diagram, approach, dissection plane, part of BCSP, biopsy details, pre-operative chemoradiotherapy, history of IBD/familial cancer and pre-op staging. The aim of this re-audit was to detect any improvement in our adherence to these guidelines in comparison with our 2019 audit. Method The forms for all colorectal cancer resections performed from 2019-2023 were interrogated for the various parameters using pathology software DART. Result Of 1615 cases, 320 were included. 30% mentioned the approach versus 78% in the previous audit. Diagrams were completed in 36% compared to 44% previously. Conversely, only 4.5% in the previous audit had information on preoperative therapy, as compared to the current 20%. There were marginal improvements in information on screening, familial cancer and IBD. In addition, the degree of completion showed significant difference in some parameters in the case of consultants who emphasized on correct completion of forms (e.g. 97% included type of surgery, 91% had diagrams). Conclusion It is important to complete the Colorectal cancer resection pathology forms according to recommended standards to enable the pathologist to provide accurate tumour staging and thus guide appropriate management. Disappointingly, we did not find significant improvement in our adherence to the recommended standards as compared to our previous audit. We therefore need to focus on wider scale education and ensure implementation of newly designed forms with active consultant involvement and a re-audit.

General practice registrars' practice in outer metropolitan Australia: a cross-sectional comparison with rural and inner metropolitan areas.

Background General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences - whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas. Methods Cross-sectional analyses of data (2016-2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors. Results Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas. Conclusions OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation.

A structured pathology request pro forma for reporting colorectal specimens: improvement in clinical information provided by junior doctors

A structured pathology request pro forma for reporting colorectal specimens: improvement in clinical information provided by junior doctors

Relationship between Age, Histologic Grade, Tumour Size, Immunohistochemical Biomarkers Expressions and Molecular Subtypes of Invasive Breast Carcinoma in Ilorin, Nigeria

Background: Background: Invasive breast carcinoma causes the most cancer-related death in women, and age is an essential non-modifiable risk factor. This study determined the relationship between age and histopathologic grade, tumor size, immunohistochemical biomarkers (ER, PR, and HER-2) expressions, and subtypes of invasive breast carcinoma. Methods: This was a retrospective hospital-based study of patients with prior histopathological diagnoses of invasive breast carcinoma. Relevant data, including age, histologic type, grade, tumor size, and hormonal receptor status, were retrieved from the archival pathology request forms. Results: The mean age of study subjects was 52.14 ± 12.14 years. The peak age group was in the 5th decade, accounting for 37.0 (32.7%) cases. Nottingham grade III invasive breast carcinoma accounted for 47 (41.6 %) cases and predominated in the 6th decade, accounting for 17 (50.0%) cases. Majority of the study subjects presented with tumor size greater than 5.0 cm (75.9%). The mean tumor size was 6.87 ± 3.20 cm and ranged from 3.2 cm to 16.0 cm. The immunohistochemical expressions of ER, PR, and HER-2 biomarkers were 36.3%, 28.3%, and 41.6%, respectively, particularly in the 5th and 6th decades. Also, Luminal A, Luminal B, Triplenegative, and HER-2 enriched subtypes occurred in 16.8%, 20.4%, 42.4%, and 20.4% cases respectively in the 5th and 6th decades. However, the triple-negative subtype was found in the 4th to 6th decades in equal proportions. Conclusion: This study observed triple-negative invasive breast carcinoma immunohistochemical subtypes with age association from the 4th to 6th decade

Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation.

In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.

Immunohistochemical and Clinicopathological Characteristics of Invasive Breast Carcinoma in Nigeria.

We aimed to study the immunohistochemical and clinicopathological characteristics of invasive breast carcinoma among Nigerian women. We conducted a retrospective assessment of female patients diagnosed with breast carcinoma at a tertiary hospital in Nigeria between 2012 and 2019. Archived pathology request forms and processed specimens (tissue blocks and slides) were used as source data in addition to the patients' demographic and other relevant data. Reports pertaining to 113 patients were assessed. Their age range was 30 to 80 years (mean = 52.1±12.1 years). Breast carcinoma was most common in patients aged 40 to 49 years (32.7%), closely followed by those aged 50 to 59 years (30.1%). Invasive ductal carcinoma was the most common histopathological subtype (94.7%). Nottingham grade III and grade II breast carcinoma accounted for 41.6% and 40.7% of the cases, respectively. Mastectomy specimens formed 68.1% of the samples. The most common tumor size (75.9%) was > 5cm (mean = 6.8±3.2cm), consistent with the most common staging of T3 (46.0%). The most common lymph node involvement was N1 (56.6%). Immunohistochemical assessment of these tumors with estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 (HER-2) biomarkers expressed positivity of 36.3%, 28.3%, and 41.6%, respectively. These tumors were immunohistochemically classified into luminal A (16.8%), luminal B (20.4%), HER-2 enriched (20.4%), and triple-negative (42.5%) subtypes. The most common immunohistochemical subtype of invasive breast carcinoma among this sample of Nigerian women was the triple-negative subtype, similar to the finding among African Americans.

Histopathologic and Molecular Features of Cutaneous Melanoma in a Moroccan Population.

Background Cutaneous cancer is the most common malignancy type, among which melanomas are considered the most aggressive and lethal. In Morocco, skin melanoma is the 25th most common cancer. To our knowledge, this is the first and largest Moroccan study specifically describing cutaneous melanoma. Materials and methods We obtained data for 100 patients diagnosed with cutaneous melanoma in the Department of Pathology of Hassan II University Hospital, Morocco. Clinical, histopathological, molecular, and follow-up data were recorded from pathology request forms and the patient's medical records. Results The mean age of our patients was 65 years old. Histologically, the most prevalent were the nodular (48%) and acro-lentiginous (38%) melanoma subtypes. A total of 66% of the patients had a Breslow thickness of >4 mm. The presence of ulceration was noted in 46% of cases. The average mitoses was 9/1 mm². A total of 44% of patients had metastatic melanoma at the time of diagnosis. The BRAF V600E mutation was found in six cases, and the C-KIT mutation in five cases. The five-year overall survival and metastasis-free survival were 85% and 15%, respectively. There was a significant correlation between Breslow thickness and Clark's level (p<0.001), histologic subtype (p=0.012), and presence of metastasis (p=0.002). There was a significant difference between the head and neck melanomas and those of the feet, particularly in the histological subtype and the presence of ulceration. BRAF V600E mutation was found in six cases of metastatic melanomas of the head and neck, of which three cases were positive for this mutation, as compared with the 23 cases of acral melanomas, which tested negative for the same mutation. Conclusion The results of our study showed that cutaneous melanomas were characterized by advanced age at diagnosis and late-stage diagnosis with a high Breslow index. The lower limbs were the most affected sites, especially in the plantar region. The acral lentiginous subtype was the most common. The presence of BRAF V600E mutation was associated with a better prognosis.

The lupus band test: A review of the sensitivity and specificity in the diagnosis of lupus erythematosus.

The lupus band test (LBT) is a direct immunofluorescence (DIF) technique which shows a band of localised immunoglobulins at the dermo-epidermal junction in lesional, non-sun-exposed skin of patients with both systemic and cutaneous lupus erythematosus (LE), and in perilesional skin of patients with systemic LE. However, low sensitivity and poor concordance between histological and clinical diagnoses warrant a review of the application of the LBT in the diagnosis of LE. To assess the sensitivity and specificity of the LBT in diagnosing LE following clinico-pathological correlation (CPC). All cases sent to our pathology department between 2011 and 2018 for DIF with a clinical query of LE were reviewed. Data collection included demographic details, pathology requests, histology and DIF reports, clinical reports and diagnoses, and serology. Of 256 histology requests, 9% (n=23) had a positive LBT. This was discordant with the prevalence of LE diagnosis, as 46.3% were diagnosed with LE following CPC. The sensitivity and specificity of the LBT for LE was 17.6% and 98.8% respectively, with a positive predictive value of 92.9% and negative predictive value of 58.2%. The LBT is not a sensitive diagnostic test for LE, but is highly specific, and should be considered as a supportive diagnostic tool for LE. This is the largest reported case series evaluating the efficacy of the LBT in the diagnosis of LE.

DP09 The lupus band test: a review of the sensitivity and specificity in the diagnosis of lupus erythematosus

Abstract The lupus band test (LBT) is a direct immunofluorescence (DIF) technique which shows a band of localized immunoglobulins at the dermoepidermal junction in lesional, non-sun-exposed skin of patients with both systemic (SLE) and cutaneous lupus erythematosus and in the perilesional skin of patients with SLE. However, low sensitivity and poor concordance between histological and clinical diagnoses warrant a review of the application of the LBT in the diagnosis of lupus erythematosus (LE). The aim of this study was to assess the sensitivity and specificity of the LBT in diagnosing LE following clinicopathological correlation (CPC). All cases sent to our pathology department between 2011 and 2018 for DIF with a clinical query of LE were reviewed. Data collection included demographic details, pathology requests, histology and DIF reports, clinical reports and diagnoses and serology. Of 256 histology requests, 9.0% (n = 23) had a positive LBT. This was discordant with the prevalence of LE diagnosis, as 46.3% were diagnosed with LE following CPC. The sensitivity and specificity of the LBT for LE were 17.6% and 98.8%, respectively, with a positive predictive value of 92.9% and negative predictive value of 58.2%. The LBT is not a sensitive diagnostic test for LE, but is highly specific and should be considered as a supportive diagnostic tool for LE. This is the largest reported case series to evaluate the efficacy of the LBT in the diagnosis of LE.

Cancer histotypes and trends in Azare, Northeast Nigeria: impact of diagnostic support disparity in data reporting.

Definitive, affordable, and timely diagnosis of cancer is key to providing data for surveillance and control programmes. Care disparities have been shown to contribute to poorer survival, especially in resource-constrained populations. Here, we describe the profile of histologically diagnosed cancers in our hospital and highlight the possible effects of inadequate diagnostic support on data reporting. We designed a retrospective cross-sectional descriptive study to review histopathology reports archived at the Department of Pathology of our hospital spanning from January 2011 to December 2022. Cases diagnosed as cancer were retrieved and classified by systems, organs and histology types alongside the patient's age and gender. The trend in the volume of pathology requests and the corresponding malignant diagnosis yield over the period was also documented. Data generated were analyzed statistically using appropriate statistics and presented as proportions and means, with the level of statistical significance set at p < 0.05. There were 488 cancers out of 3,237 histopathology requests received within the study period. Of these 316 (64.7%) were females. Overall mean age was 48.8 ± 18.6 years with a peak age at the sixth decade, females being significantly younger (46.1 versus 53.5 years; p < 0.001). The top five cancers were breast (22.7%), cervical (12.7%), prostate (11.7%), skin (10.7%) and colorectal cancers (8%). Among females, breast, cervical and ovarian cancers predominated, whereas prostate, skin and colorectal cancers, were commonest among males in decreasing order. Paediatric malignancies accounted for 3.7% of all the cases, most being small round blue cell tumours. The volume of pathology requests rose remarkably from 95 cases in 2014 to 625 cases in 2022 with a corresponding increase in cancer case diagnoses. Cancer subtypes and ranking in this study are similar to those from urban populations in Nigeria and Africa, despite the low number of cases recorded. Efforts to reduce the disease burden are warranted.

Persisting Cancer in Black Salve Treated Skin Lesions: Results of a Large 5 Year Retrospective Analysis of Australian Histopathology Specimens.

To date there has been minimal research on the use of black salve escharotics. Whether cancer persistence is a frequent finding in treatment areas, the types of lesion being treated by patients, whether rural patients are more likely to use black salve and whether current government prevention initiatives are succeeding are all issues needing investigation. This study was a large national retrospective black salve pathology case series from 2015 to 2019. Five private pathology companies with 1471 collection centers located in 5 of the 8 Australian states and Territories provided de-identified skin pathology report information where black salve treatment had been documented in the pathology request. Over the 5-year period 409 patients had treated 475 lesions with black salve. Benign lesions were present at the treatment site in 18% of cases; persisting cancer was found in 34.2% of the remaining black salve treated areas. The majority of treatment areas were located on the head and neck. Black salve caused necrosis of normal tissue when treating benign lesions, refuting claims of cancer specificity. Likelihood of black salve use increased with rurality based on Modified Monash (MM) scores. Black salve use, despite regulatory efforts, appears to be increasing with specimen numbers more than doubling from 2015 to 2019. Patients undergoing histopathological assessment of black salve treatment areas have high rates of cancer persistence. Patients are applying black salve to benign lesions and lesions in cosmetically sensitive areas. Rural patients have higher proportional rates of black salve use. The increasing incidence of black salve pathology specimens suggests current Australian black salve public health initiatives are failing.

The value of active follow up of a newly acquired hepatitis B infection - lessons for current approaches.

The standard practice of blood borne virus (BBV) follow-up in New South Wales is a passive approach of general-practitioner-led testing. The value of this approach is unknown. We undertook an active contact tracing method with the aims of investigating a potential hepatitis B source, along with accurately measuring the participation rate, to consider the value of this and other follow-up methods for future BBV investigations. Investigation of a newly-acquired hepatitis B infection was undertaken at a dental practice identified as a possible exposure site. To screen for hepatitis B infection among potential source or co-exposed clients, we actively followed up with staff and clients of the practice to request they undertake hepatitis B serology. Eligible staff and clients received up to four phone calls and were provided with a pathology request form by the public health unit (PHU). Access to free serology was offered to people who did not have access to Medicare. Reminder calls were made if serology results were not received by the PHU. As the ordering doctor, the public health physician was responsible for providing results and referring for follow-up care. Of 160 clients, 63 (39%) undertook hepatitis B serology. Of these 63, none were found to have hepatitis B infection. It was estimated the active investigation involved an extra 430 hours of PHU staff time at a cost in Australian dollars of $30,000. Active follow-up allows an accurate participation rate to be documented. Despite intense active follow-up, only 39% of clients undertook testing, bringing into question the yield of the usual approach in which active follow-up of potential mass BBV exposures is not undertaken. While active follow-up is resource intensive, it should be considered where the risks and consequences from the BBV infection are high.

The Histological Spectrum Reported on Evacuated Endometrial Tissue From Patients With Secondary Postpartum Hemorrhage: A Pilot Study.

Background/aimThis study sought to explore the possible yield of pathology requests on tissue obtained in uterine evacuation for secondary postpartum hemorrhage (SPPH) at our institution over five years.Material and methodsA content categorization of histological reports on endo-uterine tissue obtained from patients with secondary postpartum hemorrhage was undertaken. The aggregate tissue dimensions were also recorded. Additional information on the time elapsed between delivery and hospital presentation was deduced from medical records.ResultsFrom the 53 tissue samples reported, we clustered 114 descriptive mentions of phrases and terms and categorized them based on parent tissue, changes, and background cellularity. Inflammation and/or inflammatory changes were mentioned 18.4% of the time, no tissue was identified in 5.8% of instances, whilst placental tissue was encountered in 9.7% of specimens. Separately or in variable combination, decidua, decidualized tissue, hemorrhagic tissue, fibrinous material, and membranous tissue amounted to 48.5% of mentions. There was no correlation between aggregate tissue measurements and time elapsed since delivery.ConclusionNearly half of the content of histological reports on tissue evacuated SPPH patients were consistent with expected findings on a postpartum endometrium. Remnants of placental tissue were mentioned in about 10% of instances.

Detecting patients with Cushing's syndrome: The importance of initial test selection.

The recommended initial tests for suspected Cushing's syndrome are late-night salivary cortisol (LNSC), 24-hour urinary free cortisol (UFC) and the 1mg overnight dexamethasone suppression test (ONDST). These tests have higher sensitivity and specificity than serum cortisol. The aim of this study was to determine the relative frequency of theserequested tests in primary care. Initial test selection for investigation ofCushing's syndrome was audited byreviewing pathology request forms forcortisol tests made to a major community-based laboratory in 2019. Those with hypertension or adrenal incidentaloma as the documented indication for testing were included. In 214 of 272 cases (78.7%; 95% confidence interval: 73.2%, 83.3%) initial testing was by measurement of serum cortisol alone. The relatively infrequent selection of the higher sensitivity tests (ONDST, UFC and LNSC) for investigation of suspected Cushing's syndrome signifies a risk of delayed or missed diagnosis, with important implications for morbidity and mortality.

Pathologist initiated reflex BRAF mutation testing in metastatic melanoma: experience at a specialist melanoma treatment centre

Testing for BRAF mutations in metastatic melanoma is pivotal to identifying patients suitable for targeted therapy and influences treatment decisions regarding single agent versus combination immunotherapy. Knowledge of BRAF V600E immunohistochemistry (IHC) results can streamline decisions during initial oncology consultations, prior to DNA-based test results. In the absence of formal guidelines that require pathologist initiated ('reflex') BRAF mutation testing, our institution developed a local protocol to perform BRAF V600E IHC on specimens from all stage III/IV melanoma patients when the status is otherwise unknown. This study was designed to evaluate the application of this protocol in a tertiary referral pathology department. A total of 408 stage III/IV melanoma patients had tissue specimens accessioned between 1 January and 31 March in three consecutive years (from 2019 to 2021), reported by 32 individual pathologists. The BRAF mutation status was established by pathologists in 87% (352/408) of cases. When a prior BRAF mutation status was previously known, as confirmed in linked electronic records (202/408), this status had been communicated by the clinician on the pathology request form in 1% of cases (3/202). Pathologists performed BRAF V600E IHC in 153 cases (74% of cases where the status was unknown, 153/206) and testing was duplicated in 5% of cases (20/408). Reflex BRAF IHC testing was omitted in 26% of cases (53/206), often on specimens with small volume disease (cytology specimens or sentinel node biopsies) despite adequate tissue for testing. Incorporating BRAF IHC testing within routine diagnostic protocols of stage III/IV melanoma was both feasible and successful in most cases. Communication of a patient's BRAF mutation status via the pathology request form will likely improve implementation of pathologist initiated BRAF mutation testing and may result in a reduction of duplicate tests. To improve pathologist reflex testing rates, we advocate for the use of an algorithmic approach to pathologist initiated BRAF mutation testing utilising both IHC and DNA-based methodologies for stage III/IV melanoma patients.

Adequacy of clinical information in anatomical pathology requests in a tertiary hospital

Background: Absent or inadequate clinical history on pathology request forms contributes to pre-analytical errors that might affect patient safety. Aims: To audit the adequacy of clinical history on histopathology request forms and analyse the effectiveness of a targeted intervention to improve clinical history provision. Methods: This was an interventional, single-centre study over 6 months. A mandatory field was created where the reporting pathologist scored the history provided as either adequate or non-adequate (absent, inadequate or misleading clinical history). Inadequate history was defined as the requirement for additional information before a diagnosis could be rendered. Data was collected monthly. After 2 months the data was provided to individual clinicians from two outlier departments with an explanation of the audit. Chi-squared analysis was used to compare adequacy before and after the intervention. Results: 12,728 request forms were reviewed; 848 (6.7%) were non-adequate forms [of these 361 (43%) were inadequate or misleading and 487 (57%) had no clinical history]. Two departments had 109 (25%) non-adequate requests prior to the intervention; after the intervention, 47 (8.4%) were non-adequate (p≤0.001). Conclusions: A simple audit and targeted intervention can significantly improve the adequacy of clinical information in anatomical pathology request forms to improve patient safety.

Information Adequacy in Histopathology Request Forms: A Milestone in Making a Communication Bridge Between Confusion and Clarity in Medical Diagnosis.

Information contained in request forms for histopathological examinations plays a critical role in the microscopic interpretation of tissue changes. Despite its importance, studies have shown inadequacies in the information communicated by clinicians. This study aimed to determine how well the necessary information is provided on the histopathology request forms and to compare its variability among different departments of a hospital. A retrospective, 3-month, cross-sectional study was conducted to evaluate all consecutive histopathology request forms received from different departments of a tertiary, academic hospital for three months, regarding the documentation of 12 criteria. None of the 2040 requests received had all the required items. Four items of specimen description, laboratory and imaging findings, and physician contact number were available only in less than 12.5% (range between 0.05 to 12.45%) of the requests. However, four other items of patient name and contact number, physician name, and anatomical site of the lesion were documented in more than 90%. The median number of the documented items was the highest in the surgery and orthopedics (9 items) and the lowest in the pulmonology department (7 items). Comparison between departments showed that the documentation of items in the surgery department were significantly better than that of the ENT, urology, and internal medicine departments (p < 0.001). Also, the internal medicine department was significantly different from all other departments (p < 0.001) except neurosurgery (p=0.88). Our results point out a serious gap in the adequacy of pathology request forms, especially clinical items. Given the implication of such information to ensure patient safety, further studies are recommended to evaluate the impact of educational and supportive computerized interventions such as clinician education and barcoding and specimen tracking systems to help fill in the required items completely.

Impact of COVID-19 telehealth on outpatient test completion.

BackgroundPathology and imaging tests are frequently requested in the outpatient setting despite historically poor completion rates. The impact of COVID‐19 telehealth on test completion rates is unknown.AimsTo examine the impact of the COVID‐19 pandemic and telehealth transition on pathology and imaging test request and completion rates in Australian outpatient clinics.MethodsWe performed a prospective cohort study with historical controls between March–May 2019 and March–May 2020. Pathology and imaging request and completion rates were collected in review consultation patients attending gastroenterology and rheumatology outpatient clinics at a tertiary healthcare system prior and during the early phases of the COVID‐19 pandemic in Melbourne.ResultsA total of 1376 patients was included in the study. Pathology tests were requested more frequently in the COVID‐19 group (n = 582/684, 85.2%) than the control group (n = 492/692, 71.1%, P < 0.001), but completion rates were lower in the COVID‐19 group (n = 443/582, 76.1%) than the control group (n = 426/492 (86.6%), P < 0.001). Imaging tests were requested more frequently in the COVID‐19 group (n = 345/682, 50.6%) than the control group (n = 295/692, 42.6%, P = 0.003), with lower rates of completion in the COVID‐19 group (n = 229/345, 66.4%) than the control group (n = 247/295, 83.7%, P < 0.001).ConclusionsThe COVID‐19 pandemic and telehealth transition have resulted in more frequent pathology and imaging requests but fewer test completion in the outpatients setting. This study has identified new clinical risks associated with the abrupt transition to telehealth during COVID‐19 that should be explored in future studies and appropriately mitigated.

The impact of incomplete clinical information and initial biopsy technique on the histopathological diagnosis of cutaneous melanoma.

Increased rates of histopathological misdiagnosis of melanoma have been associated with incisional punch more so than shave biopsy when compared with complete excisional biopsy. It is unknown how the increasing utilisation of shave biopsy may impact melanoma diagnosis. The extent to which the provision of clinical information to the pathologist may improve diagnostic accuracy remains unclear. This study assessed the impact of both initial biopsy technique and provision of adequate clinical information to pathologists on the accuracy of histopathological diagnosis of melanoma and disease progression. We conducted a retrospective cohort with nested case-control study of all histopathological false-negative and false-positive melanoma diagnoses from January 2014 to May 2019 from the Victorian Melanoma Service electronic database. Cases were assessed for the initial biopsy type, provision of clinical information on pathology request forms and disease progression associated with false-negative diagnosis. Partial shave biopsy had higher odds of false-negative (OR 5.19, 95% CI 2.89-9.32; P < 0.001) and false-positive diagnoses (OR 1.95, 95% CI 1.45-2.63; P < 0.001) of melanoma when compared with elliptical excisional biopsy. These odds ratios were comparable with those found with incisional punch biopsy. Providing the suspected clinical diagnosis to pathologists also reduced the odds of false-negative diagnosis with melanoma progression by 3.8-fold (P = 0.02). The choice of initial biopsy technique and providing the suspected clinical diagnosis to pathologists are important for correct histopathological diagnosis of cutaneous melanoma and prevention of further disease progression.

Use of a colorectal cancer-specific pro-forma to improve junior doctors’ request form completion using rcpa structured reporting guidelines

Background and aim: Cancer reporting checklists improve completeness and quality of cancer reporting thus improving patient outcomes. This study aims to compare adequacy of pre-analytical information provided to pathologists using a colorectal cancer (CRC) specific pro-forma compared to a standard request form. Methods: Standard pathology request forms were collected from junior doctors provided with a written mock clinical case of a low anterior resection (n=15). Data collected included specific parameters relevant to CRC reporting. The same data were collected after implementation of the colorectal-specific pro-forma. Results and discussion: Other than patient details (100% vs 100%) and requesting doctor details (87% vs 87%), data collection was improved with use of a pro-forma compared to the standard from. Medical history was documented in 87% vs 20%; clinical obstruction 86% vs 0%; neoadjuvant therapy 93% vs 40%; operative procedure 100% vs 67%; specimen type 53% vs 33%; perforation 80% vs 7%; distance of rectal cancer from anal verge 80% vs 13%; involvement of adjacent organs 73% vs 0%; and existence of local residual cancer post surgery 60% vs 0%. These findings suggest use of a pro-forma request form for CRC could greatly improve quality and completeness of pre-analytical information provided.