Use of Pathology Data to Improve High-Value Treatment of Cervical Neoplasia

Barbara S. Ducatman, Mahreen Hashmi, Morgan Darrow, Melina B. Flanagan, Pamela Courtney, Alan M. Ducatman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We investigated the influence of pathology data to improve patient outcomes in the treatment of high-grade cervical neoplasia in a joint pathology and gynecology collaboration. Two of us (B.S.D. and M.D.) reviewed all cytology, colposcopy and surgical pathology results, patient history, and pregnancy outcomes from all patients with loop electrosurgical excision procedure specimens for a 33-month period (January 2011-September 2013). We used this to determine compliance to 2006 consensus guidelines for the performance of loop electrosurgical excision procedure and shared this information in 2 interprofessional and interdisciplinary educational interventions with Obstetrics/Gynecology and Pathology faculty at the end of September 2013. We simultaneously emphasized the new 2013 guidelines. During the postintervention period, we continued to provide follow-up using the parameters previously collected. Our postintervention data include 90 cases from a 27-month period (October 2013-December 2015). Our preintervention data include 331 cases in 33 months (average 10.0 per month) with 76% adherence to guidelines. Postintervention, there were 90 cases in 27 months (average 3.4 per month) and 96% adherence to the 2013 (more conservative) guidelines (P <.0001, χ2 test). Preintervention, the rate of high-grade squamous intraepithelial lesion in loop electrosurgical excision procedures was 44%, whereas postintervention, there was a 60% high-grade squamous intraepithelial lesion rate on loop electrosurgical excision procedure (P <.0087 by 2-tailed Fisher exact test). The duration between diagnosis of low-grade squamous intraepithelial lesion and loop electrosurgical excision procedure also increased significantly from a median 25.5 months preintervention to 54 months postintervention (P <.0073; Wilcoxon Kruskal-Wallis test). Postintervention, there was a marked decrease of loop electrosurgical excision procedure cases as well as better patient outcomes. We infer improved patient safety, and higher value can be achieved by providing performance-based pathologic data.

Original languageEnglish (US)
JournalAcademic Pathology
Volume3
DOIs
StatePublished - Jan 1 2016

Fingerprint

Pathology
Neoplasms
Guidelines
Gynecology
Therapeutics
Guideline Adherence
Surgical Pathology
Colposcopy
Pregnancy Outcome
Patient Safety
Obstetrics
Cell Biology
Joints
Squamous Intraepithelial Lesions of the Cervix

Keywords

  • American Society for Colposcopy and Cervical Pathology
  • cervical neoplasia
  • guidelines
  • high-grade squamous intraepithelial lesion
  • indications
  • intervention
  • loop electrosurgical excision procedure

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Use of Pathology Data to Improve High-Value Treatment of Cervical Neoplasia. / Ducatman, Barbara S.; Hashmi, Mahreen; Darrow, Morgan; Flanagan, Melina B.; Courtney, Pamela; Ducatman, Alan M.

In: Academic Pathology, Vol. 3, 01.01.2016.

Research output: Contribution to journalArticle

Ducatman, Barbara S. ; Hashmi, Mahreen ; Darrow, Morgan ; Flanagan, Melina B. ; Courtney, Pamela ; Ducatman, Alan M. / Use of Pathology Data to Improve High-Value Treatment of Cervical Neoplasia. In: Academic Pathology. 2016 ; Vol. 3.
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abstract = "We investigated the influence of pathology data to improve patient outcomes in the treatment of high-grade cervical neoplasia in a joint pathology and gynecology collaboration. Two of us (B.S.D. and M.D.) reviewed all cytology, colposcopy and surgical pathology results, patient history, and pregnancy outcomes from all patients with loop electrosurgical excision procedure specimens for a 33-month period (January 2011-September 2013). We used this to determine compliance to 2006 consensus guidelines for the performance of loop electrosurgical excision procedure and shared this information in 2 interprofessional and interdisciplinary educational interventions with Obstetrics/Gynecology and Pathology faculty at the end of September 2013. We simultaneously emphasized the new 2013 guidelines. During the postintervention period, we continued to provide follow-up using the parameters previously collected. Our postintervention data include 90 cases from a 27-month period (October 2013-December 2015). Our preintervention data include 331 cases in 33 months (average 10.0 per month) with 76{\%} adherence to guidelines. Postintervention, there were 90 cases in 27 months (average 3.4 per month) and 96{\%} adherence to the 2013 (more conservative) guidelines (P <.0001, χ2 test). Preintervention, the rate of high-grade squamous intraepithelial lesion in loop electrosurgical excision procedures was 44{\%}, whereas postintervention, there was a 60{\%} high-grade squamous intraepithelial lesion rate on loop electrosurgical excision procedure (P <.0087 by 2-tailed Fisher exact test). The duration between diagnosis of low-grade squamous intraepithelial lesion and loop electrosurgical excision procedure also increased significantly from a median 25.5 months preintervention to 54 months postintervention (P <.0073; Wilcoxon Kruskal-Wallis test). Postintervention, there was a marked decrease of loop electrosurgical excision procedure cases as well as better patient outcomes. We infer improved patient safety, and higher value can be achieved by providing performance-based pathologic data.",
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