Evaluation of turnaround times as a component of quality assurance in surgical pathology.

OBJECTIVE: As a part of a quality assurance program in anatomic pathology, a study was conducted to determine intralaboratory components of turnaround time according to specimen type, and to compare the present data with results obtained 2 years after implementing the program. DESIGN: Assessment of intralaboratory turnaround times for surgical pathology reports in a sample of 501 biopsies and surgical specimens during 1992. Comparison between the basal data obtained in 1992 and the final determination in 1994 after the implementation of an improvement action. SETTING: Surgical specimens and biopsies accessioned at the Department of Anatomic Pathology of a 913-bed acute-care teaching hospital in the city of Barcelona, Spain. STUDY SAMPLES AND PARTICIPANTS: The sample was selected from the total number of biopsies and surgical specimens accessioned on specific days by applying a table of random numbers. Data were collected from the request forms, final report copies, and laboratory registries of turnaround time-points by two resident physicians. INTERVENTIONS: All relevant information concerning turnaround times was recorded following a standardized questionnaire developed specifically for the study. MAIN OUTCOME MEASURES: The basal determination for turnaround time for pathologic diagnosis in 1992 was 5.7 days. RESULTS: The mean turnaround time for the 501 specimens was 6.24 (SD = 3.16; range = 2-27 days). Turnaround times varied substantially according to specimen type. Endoscopic biopsy samples were completed by 5.19 days (SD = 2.18). Bone biopsies were finalized within a mean of 8.11 days of receipt (SD = 3.18). For the diagnosis of lymphoproliferative disorders, most lymph node specimens required special histochemical or immunohistochemical stains. The mean turnaround time for results reporting/results transmittal to the ordering physician varied between 1.14 and 1.66 days. The 1992 annual mean turnaround time for a total of 14,862 surgical pathology specimens was 5.7 days as compared with 4.2 days for a total of 17,931 surgical pathology specimens in 1994.

Age at first full-term pregnancy, lactation and parity and risk of breast cancer: a case-control study in Spain.

A case-control study was carried out in Spain to assess associations between parity, lactation and age at first full-term pregnancy and breast cancer. From November 1989 to February 1992, 184 incident breast cancer histologically confirmed cases were interviewed and matched by age and residence to 184 hospitalized patients and 184 community controls selected by random digit dialing. Multiple logistic regression was used to assess the independent influence of each factor on the risk of breast cancer in relation to other factors included in the model. Age at first full-term pregnancy was associated with breast cancer risk with an estimated odds ratio of 3.5 (95% CI 1.41-9.83) for women with their first birth after 30 years in comparison with those whose first birth was before age 21. Breast cancer risk decreased with increasing number of full-term pregnancies, OR 0.3 (95% CI 0.16-0.78) for women who had had more than 3 full-term pregnancies in comparison with nulliparous women. Among parous women, the estimated OR for women with more than 3 children was 0.4 (95% CI 0.13-0.81) after allowance for age at first childbirth and lactation. The estimated OR was 2.6 (95% CI 1.4-4.7) for women with a positive history of breast cancer in first-degree relatives. Breast cancer was not associated with total duration of lactation. The study indicates that parity is an independent risk factor associated to breast cancer and that the women with a late age at first full-term pregnancy constitute a high-risk group.