174 The Histopathological Assessment of Gastro-Oesophageal Carcinoma Resection Specimens: A Quality Improvement project

Abstract Aim HERO consensus and Royal College of Pathologists provide guidance for the minimum dataset pathological evaluation of gastro-oesophageal cancer resection specimens. The project aimed to assess and improve adherence. Method A retrospective study of the pathological evaluation of gastro-oesophageal cancer specimens resected surgically at a tertiary cancer unit (October 2021-March 2022), and re-audit (July-December 2022) following presentation of first cycle results. Results 26 and 23 specimens in rounds 1 and 2 respectively met inclusion criteria. Adherence was good in both rounds for reporting lymphovascular invasion status (92.3% vs 100%), correct reporting as R1 if tumour cells are found within 1mm of the margin (100% vs 100%), lesser curvature fat-blocking (100% vs 100%), and reporting of lymph node response following neoadjuvant chemotherapy (100% vs 100%). Improvement was seen in testing a minimum of 15 lymph nodes (88.5% vs 91.3%) and recording of resection margins in millimetres (CRM 77.8% vs 100%; LRM 80.8% vs 82.6%). One of the three specimens with 15 node yield was retested in round 1, compared with both specimens in round 2. Reporting of peri-oesophageal fat blocking showed no improvement (88.9% vs 77.8%). Conclusions Adherence was good during cycle 1, and there was improvement in most domains following presentation of results. Of note, both specimens in the second cycle with lymph node yield 15 were re-examined. Lymph node yield is determined by both surgical technique and avid pathology node search. The project proved to be an incentive for the MDT group as a whole to seek and adhere to good reporting practice.