P132 An audit of quality of histopathology reporting of colorectal mucosal biopsies for the diagnosis and assessment of Inflammatory Bowel Disease.
Mcalinn, J.(1);Feakins, R.(1);
(1)Royal Free Hospital, Cellular Pathology, London, United Kingdom;
Background
Inflammatory Bowel Disease (IBD) biopsies form a large part of the reporting workload of most histopathology departments. Published UK and European guidelines include recommendations on how best to report these biopsies for IBD diagnosis and assessment 1,2. The purpose of this audit is to assess whether biopsies reported at our institution adhere to these guidelines and to discuss potential improvements in IBD histology reporting.
Methods
An electronic search of histopathology records was conducted using diagnostic results coded for Inflammatory Bowel Disease. The search yielded 56 cases. Percentage compliance was measured for 24 criteria under the following headings: Clinical details and processing; Macroscopic description/processing; Microscopic report; and Summary/conclusion. Satisfactory compliance was set at 90%, using the recommendations from the UK Royal College of Pathologists3.
Results
Of the 24 criteria, 14 were accepted as adhering to the guidelines. Noteworthy results for non-compliance were:
Duration of disease stated: 86%
Endoscopy findings provided: 79%
Actual copy of endoscopy report provided: 4%
Endoscopist states probability of IBD: 63%
Sampling is adequate and appropriate: 50%
Distribution within sites is recorded: 68%
Comment on presence or absence of basal plasmacytosis is made: 32%
Preference for Ulcerative Colitis or Crohn's disease is stated, or inability to subclassify is recorded: 71%
Conclusion
conclusion. Satisfactory compliance was set at 90%, using the recommendations from the UK Royal College of Pathologists3.Of the 24 criteria, 14 were accepted as adhering to the guidelines. Noteworthy results for non-compliance were:
Duration of disease stated: 86%
Endoscopy findings provided: 79%
Actual copy of endoscopy report provided: 4%
Endoscopist states probability of IBD: 63%
Sampling is adequate and appropriate: 50%
Distribution within sites is recorded: 68%
Comment on presence or absence of basal plasmacytosis is made: 32%
Preference for Ulcerative Colitis or Crohn's disease is stated, or inability to subclassify is recorded: 71%
There is potential for improvement in IBD reporting at our site.
Problems identified included lack of access to endoscopy reports, inappropriate sampling at endoscopy, and absence of endoscopy comments on the probability of IBD. Discussion of audit results with the endoscopists and creation of a regular IBD multidisciplinary team meeting (MDTM) could help to promote communication between departments and provide a route towards higher quality reporting.
Areas of concern regarding microscopic reporting and interpretation included failure to describe distribution of inflammation within sites, absence of a record of basal plasmacytosis, and failure to state a preference for Ulcerative Colitis or Crohn's disease. A lack of clarity in these areas has the potential to impact patient management negatively. Recommendations included consideration of a structured histology reporting system such as a template or the PAID approach available in the British Society of Gastroenterology guideline2.
References:
1. F Magro et al 'European consensus on the histopathology of inflammatory bowel disease'
2. RM Feakins, 'IBD biopsies: updated BSG reporting guidelines'
3. RM Feakins, RCPath Cellular pathology audit template 'An audit of quality of reporting of colorectal mucosal biopsies taken for the diagnosis and assessment of IBD'