Lymph node harvests directly influence the staging of colorectal cancer: evidence from a regional audit

Abstract

Aims:To assess the quality of histopathology reporting and accuracy of Dukes's staging of colorectal cancers in the former South Western Health region and to determine the impact of numbers of lymph nodes examined on stage ascription. Methods: Histopathology reports of colorectal cancer for 1993-7 were analysed. Completeness was assessed regarding reported numbers of lymph nodes examined, numbers found positive, Dukes's stage, and ICD9 code. Numbers of lymph nodes examined, numbers found positive, and Dukes's stage were recorded. Results from one hospital known to have high standards of reporting were compared with those from elsewhere. Results: In total, 629 reports were examined from the reference hospital and 918 from elsewhere. Fewer than one in 20 (4.3%) reports from the reference hospital were incomplete, compared with a third (36.1%) elsewhere. The average number of nodes examined for each case at the reference hospital was 18.81 and 6.41 elsewhere. The average number of positive nodes for each case was 2.47 at the reference hospital and 1.15 elsewhere. The proportion of Dukes's stage C cases was significantly higher at the reference hospital than elsewhere. Ascertainment of Dukes's stage C cases was related to number of lymph nodes examined, with optimal ascertainment levels when at least 10 and fewer than 15 nodes were examined. Conclusions: Standards of histopathology reporting, and ascertainment of Dukes's stage C, were significantly higher at the reference hospital. Variations in ascertainment levels of Dukes's stage C disease mainly resulted from variations in the numbers of lymph nodes examined.

Potential Causes of Stage Migration and Their Prognostic Implications in Colon Cancer: A Nationwide Survey of Specialist Institutions in Japan

“…The proportion of node-positive patients was shown to be higher in hospitals that had a higher NLNE in some studies performed in Western countries (22,23,25); however, this was not the case in the present study. This might be explained by differences in the NLNE in the population.…”

“…There have been some attempts to identify the hospital characteristics associated with differences in the institutional NLNE (4,22,23), and some studies have reported that teaching hospitals were more likely to have a high LN examination rate (21,24,25). Pathologists belonging to the multidisciplinary team were shown to be associated with high median LN yields (6), and the increased resources available for providing quality multidisciplinary cancer care in academic centers were considered to be a possible reason for the greater LN yield in teaching hospitals (25).…”

Is lymph node count an ideal quality indicator for cancer care?

“…Given that variations in average lymph node count have been demonstrated at the pathologist [39][40][41], surgeon [39], and institution [18,19,42] in addition to the patient and tumor level, it is difficult to determine whose quality is assessed using this indicator. Although variations in pathological and surgical quality are concerning, these concerns would be best addressed by standardizing the actual surgical technique (e.g., using standard oncologic resections for all patients) and pathologic assessment (e.g., submission of whole nodes for microscopic assessment or setting minimum time standards for evaluation of the mesentery for nodes).…”

The validity of the Royal College of Pathologists’ colorectal cancer minimum dataset within a population

“…The prognostic significance of local invasion, lymph node status and lymph node yields (Pocard et al, 1998;Wong et al, 1999;Tepper et al, 2001;Cserni et al, 2002;Goldstein, 2002;Johnson et al, 2002;Prandi et al, 2002;Joseph et al, 2003;Pheby et al, 2004;Baxter et al, 2005;Jestin et al, 2005;Sarli et al, 2005), peritoneal involvement, tumour perforation and vascular invasion (Talbot et al, 1980;Shepherd et al, 1989;Shepherd et al, 1995;Shepherd et al, 1997;Petersen et al, 2002) have all previously been documented. The results of this study confirm these findings in a large population-based setting.…”