Current Practice Patterns among Pathologists in the Assessment of Venous Invasion in Colorectal Cancer.
David E Messenger, David K Driman, Robin S McLeod, Robert H Riddell, Richard Kirsch. Mount Sinai Hospital, Toronto, ON, Canada; London Health Sciences Centre, ON, Canada
Background: Venous invasion (VI) is an independent prognostic indicator of recurrence and decreased survival in colorectal cancer. The Royal College of Pathologists (RCPath) recommends that extramural VI should be detected in at least 25% of specimens, although the College of American Pathologists' protocol does not provide a reference standard. There is widespread variability in the reported incidence of VI, which may impact on patient access to adjuvant therapy. This study aims to clarify the current practice patterns of pathologists regarding the assessment of VI and to identify factors associated with an increased self-reported VI detection rate.
Design: A population-based survey was mailed to all pathologists in the province of Ontario, Canada.
Results: Surveys were mailed to 361 pathologists. The overall response rate was 64.9%. Most pathologists were practicing in community-based centers (66.2%) and aprroximately half had been in practice for over 15 years (53.5%). A sub-specialist interest in gastrointestinal (GI) pathology was declared by 27.3% of pathologists. The majority of pathologists (70.2%) reported the detection of VI in less than 10% of resections, with only 9.1% reporting detection rates above 20%.
Standardized reporting criteria were applied by 62.1%. Special stains to enhance the detection of VI were used routinely by 11.1%, whilst 57.6% used special stains if VI was suspected with hematoxylin and eosin. Practice in a university-affiliated center, a sub-specialist interest in GI pathology and the acceptance of the 'orphan arteriole' criterion were all independently associated with a self-reported VI detection rate above 10% on multivariate analysis.
Conclusions: Self-reported VI detection rates are low among most pathologists. Even among specialist GI pathologists practicing in university-affiliated centers, few achieved the RCPath reference standard. Strategies to increase the detection of VI may be warranted, although the findings of this study first require verification with actual data from pathology reports submitted to the provincial cancer agency.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 207, Monday Afternoon