Variability in the quality of pathology reporting of margin status following breast cancer surgery

Background: Accurately determining margin status is important for breast cancer treatment. The College of American Pathologists (CAP) developed guidelines to standardize reporting of margin status. The aim of this study is to determine statewide concordance with CAP breast cancer reporting guidelines for margin status. Methods: The Vermont Breast Cancer Surveillance System (VBCSS) tracks mammography-related services provided to all women treated for breast cancer at hospitals in Vermont. These data include accompanying pathology reports, which were analyzed for descriptions of margin status. The CAP protocols have both requirements and recommendations for margin status reporting. Reports were "minimally compliant" if they adhered to the requirements stated in the CAP protocols or "maximally compliant" if they included the recommended protocols in addition to those required. Results: There were 2,016 reports that met the inclusion criteria. A total of 71.1% were minimally compliant and 37.3% were maximally compliant with the CAP guideline standards. There was a statistically significant rise in compliant reports, with minimally compliant reports increasing from 55.7% in 1998 to 79.3% in 2006, and maximally compliant reports rising from 4.7% in 1998 to 53.7% in 2006 (χ ² trend test, P <0.001) for both cohorts. Conclusions: Reporting of margin status in breast-conserving surgery varies widely. There is a significant rise in guideline compliance with margin status reporting from 1998 to 2006; however, overall compliance remains suboptimal. This study provides evidence to support the need for quality improvement measures in the implementation of CAP guidelines for reporting margin status following breast-conserving surgery.