Study of parameters to ensure quality control in histopathology reporting: A meta-analysis at a tertiary care center.

Context : When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Measuring the rate at which surgical pathology reports are amended can be used as a tool for assuring quality control in histopathology. Aim : The aim of this study was determine the parameters that can be used as an assessment tool to minimize errors in histopathology. Materials and Methods : This study was carried out at a major histopathology center. The duration of this study was from January 2001 through January 2011(ten years). Following parameters were looked for: Interpretational errors, permanent and frozen section correlation, intradepartmental consultation and cases sent for second opinion, cases brought in tissue committee meetings, audits, and cases discussed in hospital meetings. Results : A total of 28,1931 surgical pathology cases were signed out during the ten-year period. On these, addendums were issued on 5730 cases (2.0%). Additional report issued on 3521 (1.3%). Addendum/corrected report issued for 2209 cases, which was 0.7%, representing the true interpretational error. And out of this number, a second opinion was taken for 5980 cases, and 78 were sent abroad for second opinion. Conclusion : Review by a second pathologist is a strong tool to minimize errors in surgical pathology reporting. This may be done prior to or after the report is dispatched and the case is discussed in the hospital for treatment purposes. This analysis concludes that true interpretational error occurred only in 0.7% of cases, which is an attribute to the strong peer review in the department.

Malignant lymphomas in Pakistan according to the WHO classification of lymphoid neoplasms.

OBJECTIVE: To determine the spectrum of malignant lymphomas in our set up, according to the WHO classification. METHODS: All the cases diagnosed as malignant lymphoma, during the year 2005, were retrieved from the institution based tumour registry record and classified according to WHO criteria depending on the immunohistochemical results of a panel of lymphoma markers. RESULTS: The male to female ratio was 2.5:1 for almost all types of malignant lymphomas. The age range was 3 to 80 years. The frequency of Hodgkin's lymphoma, Burkitt's lymphoma and lymphoblastic lymphoma were higher amongst the children, whereas follicular lymphomas, mantle cell lymphoma and CLL/SLL were more frequently reported in 5th, 6th and 7th decades. Of the total cases 62% were nodal and 38% extranodal (majority in the GI tract). Non Hodgkin's lymphoma was more (73%) frequent than Hodgkin's disease. Mixed cellularity and nodular sclerosis were the main histological variants of Hodgkin's disease. CONCLUSIONS: Immunohistochemistry is not very frequently used in our set up and also at very few other centres. Therefore, its application should be encouraged to raise the quality of data on lymphoid neoplasms and contribute to their control.

Pattern of childhood malignancies: study of 922 cases at Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan.

OBJECTIVE: To determine the pattern of childhood cancer in northern Pakistan. DESIGN: A descriptive study. PLACE AND DURATION: January 1992 to December 2001 at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan. MATERIALS AND METHODS: All histologically diagnosed malignant childhood tumours registered with the tumour registry of our institute were retrieved from the case files. Basic epidemiological data regarding each case were collected from the request forms and analysed for the site of involvement, age distribution and histological types of tumour. RESULTS: During the ten year study period a total of 922 childhood malignancies, constituting 4.3% of all malignant tumours, were seen. Haematological malignancies (lymphomas and leukaemias) were the commonest, accounting for 50.4% in males and 37.7% in females. The haematological malignancies were followed by tumours of bone (6.3%), CNS (6.3%), and eye (4.84%) in males and soft tissue tumours as 5th common in females. Skin, renal and colorectal tumours were also in the ten commonest in both sexes and so were ovarian tumours in females. CONCLUSIONS: Lymphomas and leukaemias are the main bulk of childhood cancer. Malignant tumours were twice more common in males than females in this series.

Carcinoma of the male breast: a study of 141 cases from northern Pakistan.

Carcinoma of the male breast, histologically identical to that seen in females, is a rare malignant epithelial tumour. We retrospectively studied 141 cases of male breast carcinoma diagnosed during a ten year period (1992-2001). These tumours comprised 0.7% of all cancers, 1.1% of all malignancies in males and 5.9% of all breast carcinomas in both genders. A male to female ratio of 1:16 was observed. The peak incidence was in the age group between 50-60 years and majority of the patients were below 60 years. Most of the patients presented with a painless lump and infiltrating ductal carcinoma was the main histological type. While compared with our previous similar analysis, a highly significant increase (p< 0.0001) was found for total numbers of breast carcinoma in both sexes and total number of malignancies in males.

Analysis of gastrointestinal malignancies at the Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan.

OBJECTIVES: To determine the pattern of gastrointestinal (GI) malignancies in northern Pakistan. DESIGN: A retrospective pathology based tumour registry data analysis. PLACE AND DURATION: January 1992 to December 2001 at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan. MATERIALS AND METHODS: All histologically diagnosed malignant tumours of GI tract registered with the tumour registry were retrieved from the case files. Basic epidemiological data regarding each case was collected from the request forms and then analysed for the site of involvement, age distribution and histological types of tumours. RESULTS: During the study period a total of 2279 patients had GI tract malignancies, constituting 10.8% of all malignant tumours diagnosed in this period. Males were more frequently affected than females (M:F ratio 2.3:1). Peak incidence was in the 50-60 year age group. Colorectal tumours were most frequent (44.6%), followed by stomach (24%), esophagus (22.6%), anal (4.6%) and small intestinal (3.7%) malignancies. Ten cases of malignant tumours of the appendix, 6 in females and 4 in males were also found. The histological pattern was predictable. Statistical analysis showed that there was significant increase (P<0.01) in registration of stomach, anorectal and small intestinal tumours over the period studied,whereas esophagus and colorectal tumours remained the same. CONCLUSION: Colorectal tumours are more frequent in our material as compared to other developing countries. Peak incidence is in slightly younger age group and cases in <20 years age group are also more frequent as compared to Western studies.