Improving the availability of ER and HER2 results for Breast Cancer (BC) at breast Multi-Disciplinary team (MDT) meetings

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Purpose/Problem

Establishing the ER and HER2 status for BC patients at the time of breast MDT meeting is essential for clinicians to make informed decisions to achieve clinical management of care for patients with (BC) being compliant with NICE guidelines.

In 2017, 50-80% patients were discussed at their 1st MDT meeting with ER/HER2 results. Continuous quarterly audits of HER2 turnaround times (TAT) did not show drastic improvements, despite changes made to the laboratory workflow.

Method

In June 2018, an audit investigating HER2 result TAT and the availability of HER2 result at MDT was performed to give baseline data. An in-depth analysis of the breast core biopsy pathway (sample taken in clinic to result issued at pathology) was performed. New testing strategies were discussed between the Clinicians, Pathologists and Laboratory teams.

In august 2018, a new strategy for testing was implemented; new pathways within the laboratory were introduced and tested through a series of Plan-Do-Study-Act (PDSA) cycles.

Repeat audit in September was performed to assess the impact of these changes.

Results

• An increase in the percentage of cases available for discussion with a ER/HER2 result at MDT from 31% to 91%.
• A reduction in ER/HER2 result average TAT by 4 days.

Conclusion

Improvement of ER/HER2 testing pathways in the Cellular Pathology Department has led to an overall improvement in the ER/HER2 results TAT, and their availability MDT. This ensures compliance with NICE guidelines and has the ultimate impact on patient management.

We have raised awareness of Cellular Pathology and the processes samples must go through for analysis and ER/HER2 testing.