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AUDIT OF COMPLIANCE WITH NHSCSP
GUIDELINES REQUIRING MDT
REVIEW OF ALL CERVICAL CANCER
PATIENTS
Dr. M Bhattacharjee
Dr. A Mutton
Dr. S Nagarajan
Objective
• To ascertain whether the Histopathology of
all cervical cancer patients was discussed
at the Gynaecology MDT as per NHSCSP
guidelines.
Methods.
• A retrospective computer (SNOMED)
search of the pathology database was
performed to identify all cervical cancer
histological specimens reported during a
one year period between January and
December 2011. Those biopsies reported
in unit hospitals outside South Tees Trust
were not included.
Cont.
• Departmental protocol dictates
supplementary report to be issued on
every case reviewed at the MDT.
• Among these, cases with supplementary
report were identified.
Cont.
• In those without supplementary reports,
the MDT co-ordinator’s record was used to
ascertain whether they had been
discussed at the MDT.
• The cases were further analysed on the
basis of other parameters such as
specimen type and the type of cancer.
Results.
• Total number of specimens – 51.
• Total number of patients – 41.
Results
• Types of specimen:
•
•
•
•
Cervical punch biopsy – 12 (23.5%).
Cervical LLETZ biopsy – 22 (43.1%).
Radical hysterectomy – 16 (31.5%).
Endometrial fluid – 1 (1.9%).
Types of specimen
25
20
15
10
5
0
punch
lletz
R. hyst.
endo. fluid
Histological Tumour Types.
• Squamous cell carcinoma – 39.
• Adenocarcinoma – 10.
• Poorly differentiated carcinoma – 2.
Histological Tumour Types.
40
35
30
25
20
15
10
5
0
SCC
AdenoCa
Poorly diff.
Ca.
Results
•
•
•
•
•
31 patients had a FIGO stage. Of them
12 (39%) – 1A1
16 (52%) – 1B1
1 (3%) - 1B2
2 (6%) - 2A
Results
• Out of the 22 LLETZ biopsies 3 had no
residual tumour in the subsequent
hysterectomy specimen.
• Of them
• 1 was FIGO stage 1A1
• 2 were FIGO stage 1B1
MDT Review.
• Out of the 51 specimens:
• 49 specimens (96.1%) had a
supplementary report sequence 2 in the
pathology database to indicate MDT
review.
• 2 specimens (3.9%) had no
supplementary report in the pathology
database.
MDT Review.
• MDT co-ordinator contacted to verify
information on these 2 cases.
– One was a private case and opted to shift
region for treatment.
– The other had been discussed at the MDT
according to the MDT co-ordinator’s records.
• Therefore in reality all patients (100%
compliance) were discussed at the MDT.
Conclusions.
• Out of a total of 41 patients with cervical
cancer, 40 were discussed at the MDT
(one patient opted to shift region).
• 1 patient (2%) had no supplementary
report sequence 2 but had been discussed
at the MDT (confirmed by the MDT coordinator).
Conclusions.
• Of the cervical cancers during the study
period, 76% were squamous cell
carcinomas, 20% were adenocarcinomas
and 4% were poorly differentiated
carcinomas.
• This is broadly in line with the relative
incidence of the different histological types
of cervical cancer
THANK YOU.