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. 2021 Oct;16(10):1663-1671.
doi: 10.1016/j.jtho.2021.06.027. Epub 2021 Jul 16.

Trends in Accuracy and Comprehensiveness of Pathology Reports for Resected NSCLC in a High Mortality Area of the United States

Matthew P Smeltzer  1 , Yu-Sheng Lee  1 , Nicholas R Faris M Div  2 , Carrie Fehnel  2 , Olawale Akinbobola  2 , Meghan Meadows-Taylor  2 , David Spencer  3 , Elizabeth Sales  4 , Sherry Okun  5 , Christopher Giampapa  6 , Amal Anga  7 , Alicia Pacheco  2 , Meredith A Ray  1 , Raymond U Osarogiagbon  8
Affiliations

Trends in Accuracy and Comprehensiveness of Pathology Reports for Resected NSCLC in a High Mortality Area of the United States

Matthew P Smeltzer et al. J Thorac Oncol. 2021 Oct.

Abstract

Introduction: Complete and accurate pathology reports are vital to postoperative prognostication and management. We evaluated the impact of three interventions across a diverse group of hospitals on pathology reports of postresection NSCLC.

Methods: We evaluated pathology reports for patients who underwent curative-intent surgical resection for NSCLC, at 11 institutions within four contiguous Dartmouth Hospital Referral Regions in Arkansas, Mississippi, and Tennessee from 2004 to 2020, for completeness and accuracy, before and after the following three quality improvement interventions: education (feedback to heighten awareness); synoptic reporting; and a lymph node specimen collection kit. We compared the proportion of pathology reports with the six most important items for postoperative management (specimen type, tumor size, histologic type, pathologic [p] T-category, pN-category, margin status) across the following six patient cohorts: preintervention control, postintervention with four different combinations of interventions, and a contemporaneous nonintervention external control.

Results: In the postintervention era, the odds of reporting all key items were eight times higher than those in the preintervention era (OR = 8.3, 95 % confidence interval [CI]: 6.7-10.2, p < 0.0001). There were sixfold and eightfold increases in the odds of accurate pT- and pN-category reporting in the postintervention era compared with the preintervention era (pT OR = 5.7, 95 % CI: 4.7-6.9; pN OR = 8.0, 95 % CI: 6.5-10.0, both p < 0.0001). Within the intervention groups, the odds of reporting all six key items, accurate pT category, and accurate pN-category were highest in patients who received all three interventions.

Conclusions: Gaps in the quality of NSCLC pathologic reportage can be identified, quantified, and corrected by rationally designed interventions.

Keywords: Lymph node kit; NSCLC; Quality improvement; Synoptic reporting.

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Conflict of interest statement

The remaining authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
(A) Percentage of pathology reports with complete reporting of six key items by year from 2004 to 2020 (p < 0.0001 for trend). (B) Accuracy of pathology reporting of pT and pN by year from 2004 to 2020 (both p < 0.0001 for trend).
Figure 2.
Figure 2.
Attainment and accuracy of six key items, pT, and pN by intervention group.
See this image and copyright information in PMC

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