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

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.