Aaron Scholnik, M.D. Asif Masood, M.D.

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Aaron Scholnik, M.D. Asif Masood, M.D.

  1. 1. Aaron Scholnik, M.D. Asif Masood, M.D. Department of Medicine Division of Hematology/Oncology Michigan State University East Lansing, MI Michigan Common Pathology Lexicon Project and Reporting Formats for Cancer: An MCC Priority Review
  2. 2. Vision Develop a format which: • Is scientifically validated, clinically useable, and user friendly • Is a common format for hospitals across Michigan • Concept to be extended to other anatomical sites and pathology specimens (biopsies, excisions)
  3. 3. The Current Priority Objective Goal for a Common Lexicon: • By 2005, develop and disseminate standardized pathology protocols and reporting formats for examination of cancerous tissue specimens and determine the need for similar surgical reporting formats that include data important in making breast, cervical, colorectal, lung, and prostate cancer treatment and prognostic decisions. *Note: This did not specify breast and prostate core biopsies and colorectal polypectomies.
  4. 4. Recommendation for Updated Priority Objective Goal: • By 2006, develop and disseminate common pathology protocols and reporting formats for examination of cancerous tissue specimens and determine the need for similar surgical pathology reporting formats that include data important in making breast and prostate (including core biopsies), cervical, colorectal (including polypectomies that contain cancer), and lung cancer treatment and prognostic decisions.
  5. 5. A Focus for the Future – after 2006: • Expand the pathology protocols and reporting formats to include ALL the common tumor sites and tissue samples.
  6. 6. Pathology LEXICON • Is a collaborative effort of MDCH, MSU, and other collaborating institutions to generate a consensus format for the reporting of breast, colorectal and prostate cancers.
  7. 7. A “Call to Action” Implications for MCC Member Organizations over the next 2 years: • FOCUS- Lab Facilities/Health Care Systems • Educate health care professionals regarding the methodology and benefit of incorporating a common lexicon to improve cancer diagnosis and treatment. • Encourage participation in the pilot/evaluation phase of the draft template of the common lexicon within your facility/organization. • Support use of the finalized product (template) within all MI facilities/organizations.
  8. 8. ACOS-CoC Guidelines for Cancer Reporting • The Cancer Program Standards 2004 publication specifies that the CoC requires 90 percent of pathology reports which include a cancer diagnosis will contain the scientifically validated data elements outlined on the surgical case summary checklist of the College of American Pathologists (CAP) publication, Reporting on Cancer Specimens.
  9. 9. ACOS-CoC Guidelines for Cancer Reporting 1) A specific style of report is not required. Both synoptic or narrative reporting are acceptable, however, synoptic reporting is preferred. 2) There is no set order in which the elements must appear.
  10. 10. ACOS-CoC Guidelines for Cancer Reporting 3) No specific location for the scientifically validated elements within the pathology report has been set. For example, the scientifically validated data elements may be reported in either the Macroscopic [gross] description the Microscopic description, the Pathologic Diagnosis, or the Special Studies section of the report.
  11. 11. Steering Committee and Expert Panel • A steering committee and expert panel was convened to provide direction and advice for this important project. • For more information contact Dr. Aaron Scholnik at ascholnik@mgh.org
  12. 12. LEXICON in the Making • Gathered data from 52 facilities across MI, which report at least 250 cases/year • Hospitals were requested to submit their formats/ checklists to identify their cancer reporting practices • Each institution was expected to submit only one format for each cancer site, independent of the # of pathologists/institution • No actual pathology reports were required
  13. 13. Breast Cancer Check List 0 20 40 60 80 100 120 Specim en Type Lym ph Node Specim en Size Laterality Tum orSite Size Invasive HistologyG rade O therG rade ExtentInvasion Prim ary Tum or Lym ph Node M etastasisM argins Venous/Lym ph M icro-calcification AdditonalFindings PercentageUsage
  14. 14. Colo-Rectal Check List 0 20 40 60 80 100 120 M acroscopic Specim en Type Tum orSite Tum orConfig Tum orSize Histo-Type Histo-Grade ExtentInvasion Prim aryTum or Reg.Lym ph Node Dist.M etastatisM argins Proxim alM argin DistalM argin RadialM argin Distance from M argin Lym ph Inv. PerinuralInv. Tum orBorderInv. Peritum orLym ph Res. AdditionalPath PercentUsage
  15. 15. Prostate Cancer Check List 0 20 40 60 80 100 120M acroscopicH istology G rade Prim ary G leason Secondary G leason TotalG leason Prim ary Tum or RegionalLym phM etastasis M argin E xtra P rostatic S em inalV esicalPerineuralV enousLym phatic AdditionalP ath PercentUsage
  16. 16. Usage by Region (Macroscopic) 0 20 40 60 80 100 120 C DSE E N S SE UP W Region PercentUsage SpcType T-Site T-Conf
  17. 17. Usage by Region (Microscopic) 0 20 40 60 80 100 120 C DSE E N S SE UP W Region PercentUsage H-Type H-Grade Mrg
  18. 18. Usage by Region 0 20 40 60 80 100 120 C DSE E N S SE UP W Region PercentUsage L-inv V-inv PN-inv
  19. 19. Usage by Region 0 20 40 60 80 100 120 C DSE E N S SE UP W Region PercentUsage p-T p-N p-M
  20. 20. Usage by Region 0 20 40 60 80 100 120 C DSE E N S SE UP W Region PercentUsage TB-conf PT-LyR Adnl
  21. 21. Pathology LEXICON Template (pages 12-15) @ COLON RESECTION SPECIMEN: @ 6TH ADDITION AJCC STAGING: pT@ pN@ pM@ ---------------------------------------------------------------------------------------------------- HISTOLOGY Histologic Type: @ Histologic Grade: @ of Deepest bowel layer invasion: @ MARGINS (yes,no) Proximal and distal: @ cm from tumor to proximal/distal margin: Radial: @ cm from tumor to radial margin: VISCERAL PERITONEUM: @ for tumor VASCULAR / LYMPHATIC STATUS (yes,no) Large vessel: @ Small vessel: @ Lymphatics: @ LYMPH NODES: @ of @ nodes contain tumor ADDITIONAL PATHOLOGY: @ COMMENTS: @
  22. 22. @ PROSTECTOMY SPECIMEN: @ ADENOCARCINOMA AJCC 6TH EDITION: pT@ pN@ pM@ HISTOLOGIC PATTERN / SCORE Primary: @/5 Secondary: @/5 Tertiary: @/5 Total Gleason Score: @/10 EXTENT OF SPREAD *Right gland replaced: @ % *Left gland replaced: @ % Portion of total gland replaced: @ % Margins of excision: @ If present, location(s): @ Involvement of Apex: Extracapsular extension: @ If present, location(s): @ Seminal Vesicle Invasion: @ If present, location(s): @ Other pelvic tissue: @ If present, location(s): @ *Perineural: @ *Venous: @
  23. 23. BREAST TISSUE, @ SPECIMEN: @ carcinoma AJCC 6TH EDITION PATHOLOGIC STAGING: pT@ pN@ pM@ ------------------------------------------------------------------------------------------------------------- HISTOLOGY, INVASIVE Nottingham grade/other (specify): @ of 3 Greatest dimension: @ cm HISTOLOGY, IN SITU Type: @ Grade: @ Extent: @ LYMPH NODES Macro-metastasis ( > 2.0 mm): @ of @ nodes positive for tumor Micro-metastasis (> 0.2 but < 2.0 mm): @ of @ nodes positive for tumor Isolated Tumor cells/clusters ( < 0.2 mm): @ of @ nodes positive MARGIN ANALYSIS In situ carcinoma: @ Extent: @ If neg., cm to margin: @ cm. Invasive carcinoma: @ Extent: @ If neg., cm to margin: @ cm. PROGNOSTIC MARKERS / RECEPTORS Estrogen : @ Progesterone: @ Her2-neu: @ ADDITIONAL MICROSCOPIC Lymphatic invasion: @ Vascular invasion: @ Microcalcifications: @ Skin ulceration: @ Satellite skin nodules: @ Other: @
  24. 24. LEXICON on the Road Lexicon was presented at: • MCC Annual Meeting 2003 and received “Spirit of Collaboration” award • MICRA Annual Meeting, Sept. 2003 • MSP Meeting, 2004
  25. 25. Collaborative Efforts • Identified similar projects in Ohio and California • Held teleconferences and learned from their experiences
  26. 26. Cooperating Organizations • Michigan Department of Community Health • Michigan Society of Tumor Registrars • Michigan Society of Pathologists • American College of Surgeons • Michigan Public Health Institute – Cancer Control Services Project
  27. 27. Piloting LEXICON • Lexicon has been tried at participating institutions: Ingham Regional Medical Center, Marquette General Hospital, and Wayne State/Karmanos Cancer Institute
  28. 28. Evaluation Instrument • An evaluation instrument has been developed • This could be completed on paper or on the web
  29. 29. LEXICON – An Evolving Concept • LEXICON is all about sharing knowledge and developing grounds for mutual understanding and agreement. We are looking forward to learning from you, your thoughts, and your feedback.
  30. 30. LEXICON Agreement • Templates designed so far are in a DRAFT form only. • Please disseminate only once they are finalized.
  31. 31. A Review of the Priorities and Recommendation from the Board By 2005, develop and disseminate standardized pathology protocols and reporting formats for examination of cancerous tissue specimens and determine the need for similar surgical pathology reporting formats that include data important in making breast, cervical, colorectal, lung, and prostate cancer treatment and prognostic decisions. *Note: This did not specify breast and prostate core biopsies and colorectal polypectomies.) By 2006, develop and disseminate standardized pathology protocols and reporting formats for examination of cancerous tissue specimens and determine the need for similar surgical pathology reporting formats that include data important in making breast and prostate (including core biopsies), cervical, colorectal (including polypectomies that contain cancer), and lung, cancer treatment and prognostic decisions. Current Priority Recommendation for Update
  32. 32. Basic Lexicon Priority After final revisions, the following updated Lexicon Priority was approved by the MCC Board: • By 2006, finalize, disseminate, and evaluate basic pathology lexicons for breast, prostate, colorectal, cervix, and lung cancers to include information for making prognostic and treatment decisions. Further expand the number of pathology lexicons to include all common cancer types to enhance their adoption as a reporting system.

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