An analysis of the impact of pathology review in gynecologic cancer

Purpose: To analyze the impact of pathology review in gynecologic malignanc ies. Methods and Materials: For all new gynecologic patients seen between Decemb er 2, 1993 and January 4, 1996, we conducted a retrospective chart review t o determine if a pathology review by the institute's consultant pathologist changed the diagnosis, and if so whether the change altered patient manage ment. A total of 514 patients were seen, of whom 120 had cervical cancer, 2 26 had endometrial cancer, 122 had a primary ovarian or peritoneal malignan cy, 9 had a vaginal malignancy, 28 had vulvar cancer, and 9 had a miscellan eous gynecologic malignancy. Results: On pathology review the diagnosis changed for 200 of 599 specimens (33%). This altered management for 63 of 514 patients (12%). For patients with cervical cancer, the grade of tumor was the main change in pathologic diagnosis,,vith occasional change in the presence of lymph vascular invasio n. These did not translate into patient management alterations. Eight patie nts (1.5%) had management alterations. The changes in depth of invasion and vascular invasion altered management for 3 patients. Changes in pap smears resulted in two management alterations, and changes in histologic diagnose s altered management for 3 cases. For endometrial primaries the changes in pathologic diagnosis included grade, depth of invasion, and the presence of cervical involvement. This did alter management in 40 cases (8%). For the ovarian malignancies, the main changes were grade, extent of disease, or hi stologic classification, some of which (10 patients, 2%) resulted in altere d management. One patient,vith a vaginal lesion had the diagnosis changed, which did alter management. Of the patients diagnosed with vulvar cancer, t he pathologic diagnosis changed for 11 patients. This included changes in g rade and depth of invasion. This altered management of 2 patients. The rema ining miscellaneous gynecologic malignancies had only two diagnosis changes that altered management. Conclusions: Pathologic review of gynecologic malignancies is justified as it can alter patient management. In addition, the process facilitates coope ration of the multidisciplinary team and provides a valuable educational fo rum to enhance patient care. (C) 2000 Elsevier Science Inc.