Abstract P1-09-09: Breast cancer reporting in Lagos, implications for training and education in Africa

INTRODUCTION Breast lesions, particularly neoplasms, form a significant proportion of the histopathology laboratory work in Africa. In Nigeria about a quarter of breast neoplasms are malignant but there is no existing national programme for, early detection and management of the disease. Within a large tertiary referral centre in Lagos, attempts to standardize breast cancer reporting have been ongoing since 2005. Before this time less than 25% of breast carcinomas were graded, however, between 2007 and 2011 this has increased to an average of 75% of cases. This period of improvement corresponded to periods of increased collaboration with colleagues in Diaspora through various training and educational initiatives. OBJECTIVE The aim of this study is to determine the rate of concordance of breast cancer reporting in a large Nigerian laboratory with the minimum dataset adopted by the Royal College of Pathologists (RCPath), UK. MATERIALS AND METHODS Breast cancer cases were identified from the pathology database of a large tertiary referral centre in Lagos, Nigeria. Data was extracted from histopathology reports covering a period from January 2011 to March 2013. Only reports of female patients with DCIS and/or invasive carcinomas were included. Representative tumour slides and paraffin blocks were collected and all tumours were jointly reviewed by a UK specialist breast pathologist and a Nigerian pathologist following the RCPath guidelines to confirm diagnosis, type, grade and nodal status. Patients age and clinical data were collected from the original pathology reports. Histological parameters were compared to the RCPath minimum datasets for reporting breast carcinoma. In addition, representative tumour areas were selected and marked for tissue microarray (TMA) construction. TMA sections were stained for a range of markers including hormone receptors (ER, PR) and HER2 RESULTS A total of 115 breast carcinoma specimens were reviewed. Invasive carcinoma of no special type (NST) was the most common histological type seen(63.5%). An unusual high proportion (2.6%). of metaplastic carcinomas was recorded. Ductal carcinoma-in-situ was seen as the sole lesion in 7% of cases, no case of pure LCIS was seen. The histologic types of breast tumour stated on the report were concordant in 53.1% of cases and discordant in 46.9%. With respect to grading, 89.62% lesions were graded in the original report; 50.5% were correctly graded, 35.8% were under-graded, while 8.5% were over-graded. The lymph node status was included in 40% of cases. Hormone receptor and HER2 testing revealed 26.9% ER and 15.8% PR positivity; 6.1% positivity for HER2 overexpression and 5.1% borderline 2+. No further testing was done on the latter group. Only 26% of the 115 cases reviewed had prior hormonal and HER2 testing done. This number was insufficient to assess for concordance and discordance CONCLUSION Histopathological parameters when missing or inaccurate within histopathology reports affects standardization. In recent years, moderate progress made towards standardization of reports have been through exposure to training opportunities. Continuous training and education would ensure that all reports contain international accepted minimum dataset and enhance patient management. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-09.