Interobserver variability in the pathological assessment of malignant colorectal polyps

ArticleinBritish Journal of Surgery 91(11):1479-84 · November 2004with6 Reads
DOI: 10.1002/bjs.4588 · Source: PubMed
Abstract
Treatment of patients with malignant large bowel polyps is highly dependent on pathological evaluation. The aim of this study was to evaluate interobserver variability in the pathological assessment of endoscopically removed polyps. The records of 88 patients with colorectal cancer who underwent endoscopic removal of malignant polyps were reviewed. Study investigators reviewed the initial pathology report; three experienced gastrointestinal pathologists reviewed all slides in a blinded fashion. Interobserver variability of pathological assessment of malignant polyps was analysed by kappa statistics. Seventy-six (86 per cent) of the 88 patients had malignant polyps and 12 (14 per cent) had carcinoma in situ. Agreement between experienced pathologists was substantial with regard to T stage (kappa = 0.725), resection margin status (kappa = 0.668) and Haggitt's classification (kappa = 0.682), but comparison of initial and experienced pathologists' assessment demonstrated only moderate agreement in these areas (kappa = 0.516, kappa = 0.555 and kappa = 0.578 respectively). Agreement between even experienced pathologists was poor with respect to histological grade of differentiated adenocarcinomas (kappa = 0.163) and angiolymphatic vessel invasion (kappa = - 0.017). Pathological assessment of malignant polyps varies between observers. Specialist pathologists appear to have a higher degree of consensus among themselves than with generalist pathologists with respect to T stage. The high interobserver variability with regard to histological grade of differentiated tumours is clinically irrelevant. However, variability in the assessment of angiolymphatic vessel invasion limits the value of this measurement for clinical decision making.
    • " Lymphovascular invasion is relatively uncommon and often associated with other poor prognostic markers. 18 Its interpretation is marred by difficulty in its interpretation, lack of guidelines for establishing its presence, and significant interobserver variability in its identification. 19 Its usefulness is controversial with some studies finding an association with a poor outcome, 20 but others finding it not to be an independent risk factor. 1 Despite its arguable value, the presence of lymphovascular invasion is considered an important feature to record by the NHMRC. 12"
    [Show abstract] [Hide abstract] ABSTRACT: The pathological reporting of malignant colorectal polyps plays an important role in determining whether definitive surgical resection is required following endoscopic polypectomy. This study aims to assess the adequacy of reporting on malignant polyp specimens at Auckland Hospital and whether synoptic reporting results in an improvement. The pathology database at Auckland Hospital was accessed using a search strategy to identify all malignant polyps diagnosed between 1999 and 2011. Pathology reports were reviewed retrospectively. In total 121 malignant polyps were found. Of these, 73 were colonoscopic polypectomies, 41 were colectomy specimens, and seven transanal resections. Of the 41 colectomy specimens, 19 (46%) were reported in synoptic format compared with none of the colonoscopic polypectomies or transanal resections. The status of the margin of excision, differentiation, and presence of lymphovascular invasion were given in 100% of synoptic reports compared with 51% of non-synoptic reports. Synoptic reporting does improve the completeness of pathological reporting in malignant colorectal polyps. Currently none of the colonoscopically excised malignant polyps are reported in this format at Auckland Hospital. The development and routine use of a synoptic system for reporting on malignant polyps would give clinicians more information on which to base decisions.
    Full-text · Article · Oct 2013
    • "It should be also emphasised that a lack of understanding of current histological terminology can lead to inappropriate decision making such as surgical intervention performed on a substantial number of cases with a diagnosis of intramucosal carcinoma [11]. Wide interobserver variation has been recently shown in the diagnosis of malignant polyps between experienced and more junior pathologists, underlining the importance of a dedicated pathologist in this field [54] . Moreover, methodological discrepancies on the concept of cancer differentiate Japanese from Western pathologists. "
    [Show abstract] [Hide abstract] ABSTRACT: Colorectal adenomas containing invasive carcinoma represent the majority of early colorectal cancers. The malignant polyp carries a significant risk of lympho-haematic metastasis and mortality due to the penetration of cancerous cells into the submucosal layer. The therapeutic dilemma is whether to perform endoscopic or surgical resection. A thorough assessment of the endoscopic, histological and clinical variables is needed to unravel the best treatment for each patient. In particular, a unique staging of such lesions, based on certain histopathological features, has been deeply implicated in the therapeutic choice. Aim of this article is to review the main endoscopic, histological and clinical features of the malignant polyp in order to propose a systematic management of this lesion.
    Full-text · Article · Feb 2007
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