Significant variation in histopathological assessment of endoscopic resections for Barrett's neoplasia suggests need for consensus reporting: propositions for improvement

2021 ◽  
Author(s):  
M J van der Wel ◽  
E Klaver ◽  
R E Pouw ◽  
L A A Brosens ◽  
K Biermann ◽  
...  
Keyword(s):  
Tumor Invasion ◽  
Significant Variation ◽  
Lymphovascular Invasion ◽  
Margin Status ◽  
Endoscopic Management ◽  
Online Assessment ◽  
Depth Of Invasion ◽  
Histological Features ◽  
Node Metastases ◽  
Diagnostic Step

Abstract Endoscopic resection (ER) is an important diagnostic step in management of patients with early Barrett’s esophagus (BE) neoplasia. Based on ER specimens, an accurate histological diagnosis can be made, which guides further treatment. Based on depth of tumor invasion, differentiation grade, lymphovascular invasion, and margin status, the risk of lymph node metastases and local recurrence is judged to be low enough to justify endoscopic management, or high enough to warrant invasive surgical esophagectomy. Adequate assessment of these histological risk factors is therefore of the utmost importance. Aim of this study was to assess pathologist concordance on these histological features on ER specimens and evaluate causes of discrepancy. Of 62 challenging ER cases, one representative H&E slide and matching desmin and endothelial marker were digitalized and independently assessed by 13 dedicated GI pathologists from 8 Dutch BE expert centers, using an online assessment module. For each histological feature, concordance and discordance were calculated. Clinically relevant discordances were observed for all criteria. Grouping depth of invasion categories according to expanded endoscopic treatment criteria (T1a and T1sm1 vs. T1sm2/3), ≥1 pathologist was discrepant in 21% of cases, increasing to 45% when grouping diagnoses according to the traditional T1a versus T1b classification. For differentiation grade, lymphovascular invasion, and margin status, discordances were substantial with 27%, 42%, and 32% of cases having ≥1 discrepant pathologist, respectively. In conclusion, histological assessment of ER specimens of early BE cancer by dedicated GI pathologists shows significant discordances for all relevant histological features. We present propositions to improve definitions of diagnostic criteria.

Adherence to National Quality Forum (NQF) colorectal cancer indicators among members of the Florida Initiative for Quality Cancer Care (FIQCC) consortium

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6563-6563
Author(s):  
D. Shibata ◽  
E. Siegel ◽  
M. Malafa ◽  
J. Lee ◽  
W. Fulp ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymphovascular Invasion ◽  
Margin Status ◽  
Histologic Grade ◽  
Stage Iii ◽  
Distal Margin ◽  
Depth Of Invasion ◽  
Regional Lymph Nodes ◽  
Quality Cancer Care ◽  
National Quality

6563 Background: FIQCC is a consortium of 10 institutions participating in a comprehensive practice-based system of quality self-assessment across a number of cancer types. The NQF has endorsed several performance measures to assess the quality of care for colorectal cancer (CRC) patients. We have sought to identify adherence to NQF CRC indicators among members of FIQCC. Methods: Comprehensive chart reviews were conducted for all patients with CRC first seen in 2006 by a medical oncologist at one of the 10 FIQCC sites (2 academic/8 community). NQF quality measures included: 1) consideration or administration of chemotherapy to patients with stage III colon cancer (CC); 2) completeness of pathology reporting for CRC; 3) >12 regional lymph nodes (LN) examined for resected CC. Statistical comparisons were performed using chi-squared analysis. Results: The population consisted of 475 patients (250 men and 225 women) with a median age of 65 years (range 27–92). Chemotherapy was considered/administered in 96.5% (136/141) of stage III CC patients. With respect to CRC pathologic reporting, there was strong compliance (>90%) for reporting the number of LN examined and involved by tumor, proximal/distal margin status, depth of invasion, and histologic grade. However, only 225 of 295 (76.2%) reports documented lymphovascular invasion status. Radial margin status was included for 45% (27/60) of surgical rectal cancer specimens. Only 73.9% (173/234) of CC cases had >12 LN examined. Of the NQF measures, significant differences across practice sites were noted for the reporting of histologic grade (p = 0.0002), proximal/distal margin status (p = 0.049), and lymphovascular invasion (p < 0.0001). Conclusions: Although there was uniformly strong adherence to the application of adjuvant therapy for stage III CC across FIQCC sites, the adequacy of lymphadenectomy and LN examination for resected CC was lower and varied considerably across sites. There remains room for improvement of pathologic CRC reporting across the whole consortium as well as at individual sites. The FIQCC initiative allows for the identification of targets for global quality improvement as well as of specific measures for individual institutions. No significant financial relationships to disclose.

scholarly journals Loss of Villin Immunoexpression in Colorectal Carcinoma Is Associated with Poor Differentiation and Survival

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Jaudah Al-Maghrabi ◽  
Wafaey Gomaa ◽  
Abdelbaset Buhmeida ◽  
Mohmmad Al-Qahtani ◽  
Mahmoud Al-Ahwal
Keyword(s):  
Lymphovascular Invasion ◽  
Statistical Tests ◽  
Tumour Size ◽  
Disease Free Survival ◽  
Nodal Metastasis ◽  
Margin Status ◽  
Depth Of Invasion ◽  
Tumour Location

Background and Aims. Villin is a highly specialised protein and is expressed in intestinal and renal proximal tubular epithelium. It was detected in colorectal carcinomas (CRC) and other nongastrointestinal tumours. The aim of the current study is to investigate the immunohistochemical expression of villin in a subset of primary CRC and determine its relation to tumour differentiation, invasion, nodal metastasis, recurrence, and disease-free survival. Patients and Methods. Paraffin blocks of 93 cases of CRC were retrieved constituting 93 primary CRC and 58 adjacent normal mucosa. Immunohistochemistry was performed using antivillin antibody. The extent (%) of villin immunoexpression was categorised for statistical analysis. Statistical tests were used to determine the association of villin with clinicopathological characteristics: age, sex, tumour location, tumour size, depth of invasion, tumour grade, nodal metastasis, lymphovascular invasion, margin status, recurrence, and survival. Results. Villin immunostaining results showed that villin is downregulated in CRC. Villin has no association with age, sex, tumour location, depth of invasion, nodal metastasis, lymphovascular invasion, margin status, and recurrence. However, villin is expressed in higher rate in CRC less than 5 cm, well- and moderately differentiated CRC. Poor survival was associated with tumour with low villin immunoexpression. Conclusion. Villin was downregulated in CRC. Villin immunoexpression in CRC is associated with better survival, well-differentiated tumours, and small-sized tumours. Villin has no significant association with disease recurrence or nodal metastasis. More in vivo and in vitro studies are required for further elucidation of how villin may be involved in CRC.

scholarly journals Változások a korai stádiumú operált méhtestcarcinoma sugárkezelésének indikációjában. Újabb stádiumbeosztás, prediktív tényezők. Tanulságok saját eredményeink alapján

2016 ◽  
Vol 157 (27) ◽  
pp. 1059-1064
Author(s):  
Zsuzsa Póti ◽  
Csilla Katona ◽  
Tibor Szalai ◽  
Árpád Mayer
Keyword(s):  
Tumor Invasion ◽  
Lymphovascular Invasion ◽  
Early Stage ◽  
Postoperative Radiotherapy ◽  
Emission Tomography ◽  
Resonance Imaging ◽  
Positron Emission ◽  
Endometrium Carcinoma ◽  
Node Metastases ◽  
Growth Of Tumor

Optimal postoperative radiotherapy indications for early-stage operated endometrial cancers have drastically changed with the new imaging generation (magnetic resonance imaging, positron emission tomography/computed tomography) and more detailed pathomorphology. The depth and growth of tumor invasion, presence or absence of the lymph node metastases, grading and lymphovascular invasion are the most important factors to predict the progression and to influence the prognosis. In 2016, on the basis of these, the European Gynecologist Oncology and Radiotherapy Society published a report in which they proposed unanimously indications for postoperative radio- and/or radiochemotherapy. The basis of their work was prospective multilevel randomized investigations which could avoid over- or undertreatment hazards. The results obtained by the authors of this article from 164 operated patients in early-stage endometrium carcinoma seem to be acceptable, in spite of the fact that their earlier radiotherapy indication was different and in the pathological description lymphovascular invasion was not included and the grading was not always applied. Orv. Hetil., 2016, 157(27),1059–1064.

Detection of Lymphovascular Invasion in Vulvar Cancer by D2-40 (Podoplanin) as a Predictor for Inguinal Lymph Node Metastases

Onkologie ◽  
2009 ◽  
Vol 32 (12) ◽  
pp. 732-738 ◽  
Author(s):  
Michael Braun ◽  
Eva Wardelmann ◽  
Manuel Debald ◽  
Gisela Walgenbach-Bruenagel ◽  
Tobias Höller ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Lymphovascular Invasion ◽  
Vulvar Cancer ◽  
Inguinal Lymph Node ◽  
Node Metastases

scholarly journals Retrospective analysis of LNM risk factors and the effect of chemotherapy in early colorectal cancer: A Chinese multicenter study

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chunyan Zeng ◽  
Dandan Xiong ◽  
Fei Cheng ◽  
Qingtian Luo ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Multicenter Study ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Early Colorectal Cancer ◽  
Depth Of Invasion ◽  
Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC. Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P = 0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P = 0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P = 0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P = 0.729 and 0.052). Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

RA08.04: IMPORTANT ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS FOR PREDICTING SUBMUCOSAL TUMOR INVASION IN SUPERFICIAL BARRETT ADENOCARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 38-38
Author(s):  
Ken Namikawa ◽  
Kaoru Nakano ◽  
Naoki Akazawa ◽  
Akiyoshi Ishiyama ◽  
Jyunko Fujisaki
Keyword(s):  
Tumor Size ◽  
Predictive Value ◽  
Tumor Invasion ◽  
Submucosal Invasion ◽  
Depth Of Invasion ◽  
Tumor Diameter ◽  
Poorly Differentiated Adenocarcinoma ◽  
Macroscopic Type ◽  
Biopsy Specimens ◽  
Poorly Differentiated

Abstract Background Predicting the depth of invasion of superficial Barrett adenocarcinoma (s-BA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics related to s-BA submucosal invasion. Methods We retrospectively reviewed 67 lesions in 63 cases with pathologically defined s-BA (SSBE, n = 56; LSBE, n = 7) that underwent endoscopic resection at our hospital from January 2004 to December 2017. Initial treatment included endoscopic mucosal resection (EMR) (n = 4), endoscopic submucosal dissection (ESD) (n = 99), and surgery (n = 33). We grouped 133 lesions into two groups based on depth of tumor invasion: group M comprised 87 intramucosal tumors and group SM comprised 49 submucosal tumors. We defined characteristic criteria for submucosal invasion as follows: tumor size ≥ 21 mm, complex macroscopic type; composed of > 2 macroscopic types, biopsy-por; biopsy specimens including poorly differentiated adenocarcinoma. Endoscopic ultrasound (EUS) was performed only in cases in which predicting the depth of tumor invasion was difficult. Results In group M, the median tumor diameter was 13 (range, 1–82) mm and included 68 SSBEs and 19 LSBEs. In group SM, the median tumor diameter was 23 (range, 4–55) mm and included 41 SSBEs and 8 LSBEs. Tumors larger than 21 mm were seen in 12 (13.8%) patients in group M and 25 (51.0%) in group SM. Complex macroscopic type tumors were present in 20 patients (23.0%) in group M and 30 (61.2%) in group SM. Biopsy-por was present in 2 (2.3%) in group M and 12 (24.5%) in group SM. Multivariate analysis indicated the above three characteristics as independent predictors of submucosal invasion; in particular, biopsy-por was highly significant (P < 0.001, odds ratio, 10.81). EUS was performed in 55 lesions including 28 tumors invading the submucosa. Sensitivity, specificity, positive predictive value, and negative predictive value of EUS for predicting submucosal invasion were 46.4%, 70.4%, 61.9%, and 57.5%, respectively. Conclusion Tumor size ≥ 21 mm, complex macroscopic type, and biopsy specimens including poorly differentiated adenocarcinoma were independent predictors of submucosal invasion. Specificity of EUS was relatively high for cases that were difficult to predict depth of tumor invasion. Disclosure All authors have declared no conflicts of interest.

Pathologic Issues in the Treatment of Endoscopically Removed Malignant Colorectal Polyps

2007 ◽  
Vol 5 (9) ◽  
pp. 991-996 ◽  
Author(s):  
Harry S. Cooper
Keyword(s):  
Lymphovascular Invasion ◽  
Early Stage ◽  
Colorectal Polyps ◽  
Endoscopic Polypectomy ◽  
Pathology Report ◽  
Depth Of Invasion ◽  
Close Margin ◽  
Invasive Adenocarcinoma ◽  
Negative Resection Margin ◽  
Pathologic Evaluation

Endoscopically removed malignant colorectal polyps are early stage cancers for which treatment depends on histopathologic findings. For accurate pathologic evaluation, the polyps should be received in 1 piece because margins cannot be accurately assessed in fragmented polyps. Polyps with grade I or II cancer, no lymphovascular invasion, and a negative resection margin can be successfully treated with endoscopic polypectomy, whereas those with grade III cancer, lymphovascular invasion, or a positive or close margin require definitive surgical resection after endoscopic polypectomy. Potentially new significant parameters for patient management are depth of invasion and tumor budding. The pathology report must be clear and concise, indicating all relevant important parameters. The pathologist must differentiate invasive adenocarcinoma from intramucosal adenocarcinoma and pseudo-invasion.

Time to vulva cancer relapses in dependence on different factors.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16513-e16513
Author(s):  
Galina Nerodo ◽  
Victoria Aleksandrovna Ivanova ◽  
Ekaterina Alekseevna Nerodo
Keyword(s):  
Tumor Invasion ◽  
Complex Method ◽  
Depth Of Invasion ◽  
Combined Method ◽  
Invasion Depth ◽  
Treatment Results ◽  
Significant Difference ◽  
The Times ◽  
Time To Relapse ◽  
Vulva Cancer

e16513 Background: The time to relapses was investigated in dependence on different factors. Methods: We examined 809 vulva cancer patients to evaluate frequency and average time to relapse depending on grades, invasion depth and method of treatment. Results: We found out that 25.09% (203 from 809) of patients had a relapse. For the I grade the relapse was observed in 18.29% patients after 59.3 months on average, for the II grade – in 20.5% after 46.9 months, for the III grade – in 26.6% after 16.8 months, for the IV grade – in 46.2% patients after 7.2 months respectively. The patients of the II grade with tumor invasion of 1-2 mm had a relapse after 61.2 months, with invasion of 3-4 mm – after 42.1, with more than 5 mm – after 38.5 months on average correspondingly. For patients of the III grade with tumor invasion less than 5 mm the average time to relapse was 19.9 months, with invasion more than 5 mm – 12.6 months. There is not significant difference between the times to relapses of early grades patients treated with combined method or complex method with chemotherapy. However for the patients of the III grade the chemotherapy has prolonged the time to relapse from 13.5 to 18.1 months. Conclusions: The relapses of vulva cancer were observed in 25.09% of all patients. The grade, depth of invasion and chemotherapy as a part of complex treatment of III-IV grades patients have considerable influence on the time to relapse.

Multivariate analysis of prognostic factors among 706 mucosal melanoma patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9569-9569
Author(s):  
Bin Lian ◽  
Chuanliang Cui ◽  
Li Zhou ◽  
Xin Song ◽  
Xiaoshi Zhang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Survival Rate ◽  
Lymph Node Metastases ◽  
Distant Metastases ◽  
Mucosal Melanoma ◽  
Depth Of Invasion ◽  
Prognostic Analysis ◽  
Node Metastases

9569 Background: Mucosal melanoma is rare and associated with extremely poor prognosis. Little is known about its outcome and prognostic analysis. In this study, we evaluated prognostic factors among mucosal melanomas. Methods: The survival rates, Relapse Free Survival (RFS), Overall Survival (OS) and prognostic factors were compared for 706 mucosal melanomas at different anatomical sites. Results: Mucosal melanoma from nasal pharyngeal and oral (268 pts), upper and lower gastrointestinal (GI) (221 pts), gynecological and urological (196 pts) had a similar survival with a 1-y survival rate (88%, 83%, 86%), 2-y survival rate (66%, 57%, 61%), 5-y survival rate (27%, 16%, 20%), respectively. Multivariate analysis revealed that Depth of Invasion (p < 0.001), Lymph node metastases (p < 0.001), Distant metastases (p < 0.001) were three independent prognostic factors for OS among 706 pts. Anatomical site (p = 0.031), Depth of Invasion (p < 0.001), Lymph node metastases (p < 0.001) were three independent prognostic factors for RFS among 543 pts. KPS status, Depth of Invasion, Lymph node metastases, Distant metastases were independent factors for OS among nasal pharyngeal and oral pts. Depth of Invasion, Lymph node metastases, CKIT Mutation were independent factors for RFS among nasal pharyngeal and oral pts. Gender, Lymph node metastases, Distant metastases were independent factors for OS among GI pts. Gender, Depth of Invasion, Lymph node metastases were independent factors for RFS among GI pts. Lymph node metastases, Distant metastases were independent factors for OS among Gynecological and Urological pts. Depth of Invasion, Lymph node metastases were independent factors for RFS among Gynecological and Urological pts. Conclusions: This is the first prognostic analysis for mucosal melanoma with the largest sample size for the first time. with few exceptions, It revealed that Depth of Invasion, Lymph node metastases, Distant metastases were independent prognostic factors for OS, Depth of Invasion and Lymph node metastases were independent prognostic factors for RFS. These results should be incorporated into the establishment of stage system and design of future clinical trials involving patients with mucosal melanoma.

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