Application of Next Generation Quality/Statistical Process Control and Expert-Led Case Review to Increase the Consistency of Diagnostic Rates in Precancerous Colorectal Polyps

Bonert, Michael; Collins, Andrew; Xenodemetropoulos, Ted; Dmetrichuk, Jennifer M.; Al-Haddad, Sahar; Major, Pierre; Naqvi, Asghar

doi:10.1097/qmh.0000000000000299

Cited by 2 publications

(1 citation statement)

References 28 publications

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“…Our prior work examining diagnostic consistency suggests that pathologists have stable diagnostic rates [ 21 ] and that those rates with individualized feedback are modifiable, i.e. the diagnostic consistency could be improved via next generation quality [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections

Srivastava,

Kak,

Major

et al. 2024

PLoS ONE

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Background Lymph node status and lymph node count (LNC) are predictors of colorectal cancer outcome. Under-sampling of lymph nodes may lead to clinically relevant stage migration. Methods Colorectal cancer (CRC) cases with a synoptic report, accessioned 2012–2020 at a regional laboratory, were extracted and retrospectively studied. LNC, positive lymph node count (PLNC), tumour deposits present (TDpos), and ‘y’ (staging) prefix (YS) were retrieved and tabulated by pathologist using custom software. Statistical analyses were done with R. Data and results The cohort had 2,543 CRC resections. Seventeen pathologists interpreted >50 cases (range: 56–356) each and collectively saw 2,074. After cases with unavailable data were purged, 2,028 cases remained with 43,996 lymph nodes, of which 2,637/43,996 were positive. 368 cases had a ‘y’ prefix, and 379 had TDpos. The 17 pathologists’ median LNC/case was 19.0 (range: 14.0–24.0), and the mean PLNC per case was 1.4 (range: 1.0–2.0). Kruskal-Wallis rank sum tests showed there were differences in LNC (p<0.001) among pathologists; however, PLNC did not show this association (p = 0.2917). T-tests showed that mean LNC (p<0.001) and PLNC (p<0.035) differed between YS. 138 of 2,028 cases had less than the 12 LNC target. Logistic regression revealed a strong association between meeting the LNC target and pathologist (p<0.001) but TDpos was non-predictive (p = 0.4736). Conclusions Positive lymph node call rate has a good consistency in the laboratory; however, lymph node count varies significantly between pathologists. Standardized counting criteria are needed to improve uniformity and could be aided by synoptic reporting data.

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Section: Discussionmentioning

confidence: 99%

What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections

Srivastava,

Kak,

Major

et al. 2024

PLoS ONE

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Stability of diagnostic rate in a cohort of 38,813 colorectal polyp specimens and implications for histomorphology and statistical process control

Bonert

Naqvi

Rahman

et al. 2021

Sci Rep

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This work sought to quantify pathologists’ diagnostic bias over time in their evaluation of colorectal polyps to assess how this may impact the utility of statistical process control (SPC). All colorectal polyp specimens(CRPS) for 2011–2017 in a region were categorized using a validated free text string matching algorithm. Pathologist diagnostic rates (PDRs) for high grade dysplasia (HGD), tubular adenoma (TA_ad), villous morphology (TVA + VA), sessile serrated adenoma (SSA) and hyperplastic polyp (HP), were assessed (1) for each pathologist in yearly intervals with control charts (CCs), and (2) with a generalized linear model (GLM). The study included 64,115 CRPS. Fifteen pathologists each interpreted > 150 CRPS/year in all years and together diagnosed 38,813. The number of pathologists (of 15) with zero or one (p < 0.05) outlier in seven years, compared to their overall PDR, was 13, 9, 9, 5 and 9 for HGD, TVA + VA, TA_ad, HP and SSA respectively. The GLM confirmed, for the subset where pathologists/endoscopists saw > 600 CRPS each(total 52,760 CRPS), that pathologist, endoscopist, anatomical location and year were all strongly correlated (all p < 0.0001) with the diagnosis. The moderate PDR stability over time supports the hypothesis that diagnostic rates are amendable to calibration via SPC and outcome data.

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Application of Next Generation Quality/Statistical Process Control and Expert-Led Case Review to Increase the Consistency of Diagnostic Rates in Precancerous Colorectal Polyps

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 2 publications

References 28 publications

What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections

What is your count? An observational study of lymph node counting in 2,028 colorectal cancer resections

Stability of diagnostic rate in a cohort of 38,813 colorectal polyp specimens and implications for histomorphology and statistical process control

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