759 Lost in Translation: Breast Surgery Pathology Reporting Audit

Abstract Aim Accurate and consistent reporting of surgical specimens is essential to guide appropriate clinical decisions in management of patients with breast cancer. In 2017 NHS England consolidated pathology services with hub and spoke networks which aimed to improve efficiency and reduce variation in service delivery. Following a Serious Incident within our well-performing breast unit, it was clear that strengthening communication by standardised reporting in merged services improves patient safety. An audit was performed to review reporting consistency. Method The Royal College of Pathologists (RCPath) guideline 'Pathology reporting of breast disease in surgical excision specimens' describes a dataset that 90% of reports should include. We reviewed breast cancer operations from October to December 2021 at one unit and analysed reports for inclusion of guideline components. Margin and lymph node re-excisions were excluded. Results Of 126 reports 65 were included. Procedures were wide local excision (65%) and mastectomy (35%). Specimen type, histological grade, and presence of invasive disease were well reported but other items were inconsistently documented, including date of surgery (0%), core biopsy site identified (1.5%) and presence of microinvasion (4.3%). Conclusions There was variation in the pathology reporting of breast cancer. Multi-disciplinary team clinical decisions are based upon these results and error could arise if components are omitted or incomplete when reports are published. Investigating incidents drives change that makes services robust and enhances patient safety. Service improvement considerations need not be onerous or impact tight demand and capacity needs. We propose implementation of a streamlined reporting proforma that includes RCPath core dataset components.