The efficiency of right hemicolectomy specimen grossing and blocking: a quality assurance study

Abstract

Pathologists’ Assistants (PAs) are increasingly utilized in the pathology laboratory to perform grossing duties. With this increase in physician extenders performing gross dissections, steps should be taken to standardize grossing guidelines so that Pathologists are always given adequate and informative tissue sections. This study aims to analyze the impact of the introduction of a grossing manual on the grossing quality for malignant right hemicolectomy specimens in Manitoba, Canada. Five aspects of colorectal cancer grossing were analyzed in 88 pre-manual specimens and 92 post-manual specimens, including: total number of blocks submitted to histology, number of blocks containing tumour submitted, number of blocks containing margin submitted, lymph node submission, and the submission of non-informative tissue sections. After introduction of the manual, lymph node submission utilized significantly less blocks, and the submission of multiple types of non-informative tissue blocks (such as the sampling of anastomotic donuts when the margin is well-clear) significantly decreased. Additionally, the grossing manual recommends no more than five blocks of tissue including tumour should be submitted, however the submission of six or more tumour sections significantly increased and the total number of blocks submitted per case did not change after the manual’s introduction. Based on this study’s findings, two recommendations are made for future versions of the grossing manual: (1) sections of proximal and distal margin may not need to be submitted if the tumour is greater than 2cm from margin, and the tumour is not diffusely infiltrative or associated with inflammatory bowel disease; and (2) PAs should consult with a Senior PA or Pathologist when submitting six or more blocks. These recommendations will likely improve blocking efficiency and decrease costs associated with the processing of blocks, while providing patients with the same quality of care.