Quality statement 7: Tissue diagnosis

Quality statement

People with lung cancer have adequate tissue samples taken in a suitable form to provide a complete pathological diagnosis including tumour typing and sub‑typing, and analysis of predictive markers.

Quality measure

Structure: Evidence of local arrangements and written clinical protocols to ensure that people with lung cancer have adequate tissue samples taken in a suitable form to provide a complete pathological diagnosis including tumour typing and sub‑typing, and analysis of predictive markers.

Process:

a) Proportion of people with lung cancer who have a second diagnostic test in order to obtain additional pathological information.

Numerator – the number of people in the denominator who have a second diagnostic test in order to obtain additional pathological information.

Denominator – the number of people with lung cancer.

b) Proportion of people with lung cancer who have a pathological diagnosis.

Numerator – the number of people in the denominator who have a pathological diagnosis.

Denominator – the number of people with lung cancer.

c) Proportion of people with lung cancer who have a tumour type identified.

Numerator – the number of people in the denominator who have a tumour type identified.

Denominator – the number of people with lung cancer.

d) Proportion of people with non‑small‑cell lung cancer who have a tumour sub‑type identified.

Numerator – the number of people in the denominator who have a tumour sub‑type identified.

Denominator – the number of people with non‑small‑cell lung cancer.

e) Proportion of people with non‑small‑cell lung cancer where reported tumour sub‑type is 'not otherwise specified'.

Numerator – the number of people in the denominator where reported tumour sub‑type is 'not otherwise specified'.

Denominator – the number of people with non‑small‑cell lung cancer.

f) Proportion of people with lung cancer who have an analysis of predictive markers.

Numerator – the number of people in the denominator who have an analysis of predictive markers.

Denominator – the number of people with lung cancer.

What the quality statement means for each audience

Service providers ensure there are systems in place for people with lung cancer to have adequate tissue samples taken in a suitable form to provide a complete pathological diagnosis including tumour typing and sub‑typing, and analysis of predictive markers.

Healthcare professionals take adequate tissue samples in a suitable form to provide a complete pathological diagnosis including tumour typing and sub‑typing, and analysis of predictive markers, for people with lung cancer.

Commissioners ensure they commission services for people with lung cancer to have adequate tissue samples taken in a suitable form to provide a complete pathological diagnosis including tumour typing and sub‑typing, and analysis of predictive markers.

People with lung cancer have a sample of tumour tissue removed for laboratory analysis, which will give enough information about the type and sub‑type of the tumour to give a complete diagnosis.

Source guidance

Data source

Structure: Local data collection.

Process:

a) Local data collection.

b) The Health and Social Care Information Centre National Lung Cancer Data Audit collects data on the proportion of patients submitted to the audit who have a histologically or cytologically confirmed diagnosis of lung cancer.

c) and f) Local data collection.

d) and e) National Lung Cancer Data Audit collects data on the proportion of patients submitted to the audit with non‑small‑cell lung cancer where the sub‑type is limited to 'not otherwise specified'.

Definitions

Tumour sub‑typing is the pathological classification of tumours into sub‑types according to the differentiation of the cell type.

Predictive markers are molecular characteristics of the tumour that may predict response to systemic therapy.

A complete pathological diagnosis is set out in The Royal College of Pathologists Dataset for lung cancer histopathology reports.