MAMMOGRAPHICALLY DIRECTED BREAST BIOPSIES - A COLLEGE-OF-AMERICAN-PATHOLOGISTS Q-PROBES STUDY OF CLINICAL PHYSICIAN EXPECTATIONS AND OF SPECIMEN HANDLING AND REPORTING CHARACTERISTICS IN 434 INSTITUTIONS

Objectives.-To determine (1) the information that clinical physicians want in surgical pathology reports of biopsies performed for mammograp hic abnormalities, (2) how specimens are received and processed, and ( 3) what information is actually present in pathology reports. Design.- The standard data collection and questionnaire format of the College o f American Pathologists' Q-Probes quality improvement program was used . Laboratories (1) surveyed clinical physicians working in selected sp ecialties involved in the care of patients with breast disease concern ing what information they wanted in a surgical pathology report, (2) d ocumented laboratory specimen handling for 20 consecutive breast biops y tissues obtained to investigate mammographic abnormalities, and (3) documented the information content of surgical pathology reports of th ese cases. Participants.-Four hundred thirty-four participating labora tories surveyed 1469 clinical physicians and collected information on 7300 cases regarding specimen processing and report content. Results.- Clinical physicians were unanimous in the majority of items they desir ed for patient care. The information, however, differed depending on t he diagnosis. In processing of tissues, 89% of specimens were received without fixative. In 83% of cases, radiographs were performed. Eighty -two percent of specimens were marked in some manner, but in only 45% of cases was a report of the radiographic abnormality given to the Pat hology Department. The median number of blocks used to sample the lesi on and the whole specimen was three and six blocks, respectively. The latter correlated with specimen size. Fifty-seven (13%) surgical patho logy laboratories had radiography equipment. Radiographs of specimens and tissue blocks were made in 5% and 4% of cases, respectively. Corre lation of a mammographic abnormality with a microscopic finding was do cumented in 62% of reports. In 92% of malignant cases the margin statu s was reported, and 77% of reports contained the lesion size. Eighty-t hree percent of reports with invasive carcinoma stated the tumor grade , and 76% stated the extent of intraductal carcinoma. The percentage o f reports containing information items was significantly higher (P < . 05) for institutions using checklists. Summary.-This multi-institution al Q-Probes study describes the current clinical expectations and labo ratory practices associated with mammographically directed biopsies. D isparities between pathology reporting and clinician desires, as well as radiology and laboratory specimen handling practices, have been ide ntified and may help focus future quality improvement efforts.