Histopathology reporting in large bowel cancer.

Abstract

SUMMARY A review of histopathology reports on 2046 patients in the large bowel cancer project showed considerable observer variation in histological grading, Dukes staging, and lymph node harvest. These parameters have a well-established relationship to prognosis, but, if they are to be applied for both clinical and research purposes, they must be assessed consistently. A minimal level of information which should be recorded from a resection specimen is suggested, with a description of the methods by which this information can be obtained.The large bowel cancer project was initiated in 1976, and currently specimens are sent to the 22 histopathology departments from the 84 participating surgeons. Although many departments have more than one histopathologist to deal with these specimens, they have been treated as 22 observers for this analysis.The objective of this part of the study was to assess the consistency of reports on the histopathology of the resected specimens. We anticipated that there might be considerable observer variation in histological grading, which is a subjective process, but we did not expect significant differences in the staging of local tumour spread, which is an objective assessment with sharp delineation between subgroups, or in lymph node harvest. We report here the results on 2046 resected tumours. We found clinically important and statistically significant differences between histopathology departments in the reporting of these specimens. Differences between hospitals have been calculated using the x2 test for independent samples. (Fig. 1). The difference between observers was statistically significant (p < 0-001). Some lack of uniformity is inevitable in grading, but the order of difference shown can be due only to different techniques of assessment. In the present study of 2046 specimens 26 0 were well, 58% moderately, and 16% poorly differentiated;however, the proportion placed in each grade by the different observers varied widely: well-differentiated 3-93 %, moderately 8-82 %, and poorly 5-30 %

Colorectal Carcinoma in Malaysians: DNA Mismatch Repair Pattern in a Multiethnic Population

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Loss of membranous Ep-CAM in budding colorectal carcinoma cells

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The influence of tumour cell DNA content on survival in colorectal cancer: a detailed analysis

“…Other parameters have been suggested which may help to define prognosis. Histological grade has been shown to give prognostic information (Phillips et al, 1984) but tends to be subjective with wide variation in grading between observers (Blenkinsopp et al, 1981) and a tendency for the majority of tumours to be graded as moderately differentiated, reducing the discrimination of this particular parameter. Tumour cell DNA content can be rapidly and easily measured using flow cytometry either in fresh tissue (Quirke et al, 1985) or in paraffin-embedded material (Hedley et al, 1983).…”