56 - CAP Requirements for Breast Pathology: You Want Me to do What?
Monday, April 6, 2020
8:00 AM – 8:30 AM
Location: Forum General
Prior to initiating cancer therapy, a diagnostic pathology test confirming and classifying the malignancy is essential to ensure accurate, effective, and safe patient management regardless of patient geographic location. In some situations, a simple blood test using a point of care device is adequate, however, most malignancies require a tissue diagnosis from a skilled pathologist, and this comprises multiple steps and requires that special studies be performed. In breast cancer, standard of care requires a tissue biopsy be reviewed by a pathologist for grading and subtyping of the cancer, and then predictive biomarker studies are performed that include hormone receptors (estrogen and progesterone; ER and PR) and human epidermal growth factor receptor 2 (HER2) mutations. Biomarker studies are typically immunohistochemistry-based with potential confirmation of equivocal HER2 results by more expensive HER2 in situ hybridization testing. With positive tests, patients are eligible for either tamoxifen (for ER/PR) or monoclonal antibody therapy (for HER2). In a setting where these therapies are not available—unfortunate but often true—performing biomarker studies has utility only if gathering epidemiological data to support the acquisition of therapy. However, the primary morphological review of the cancer using a gross description, gross measurements, and histology, collectively referred to as “pathology review”, is still essential prior to treatment. As clinical guidelines for cancer have been reviewed and revised to account for resource-stratified approaches, the same has not been considered for pathology review. The challenges of the current classifications systems in the context of global health are being met by innovative solutions which may change the face of pathology practice.
Understand the complexity and nuances of current CAP reporting guidelines for cancer in the context of domestic and global health practice
Recognize the challenges of resource-constrained health systems in dealing with suspected breast cancer patients including the diagnostic laboratory
Define the role of pathology report parameters for both specific patient care and specific quality metrics, recognizing the integration and value of both