Missing parameters in malignant polyp histology reports: can appropriate decisions be made?

Zammit, Andrew P; Brown, Ian; Hooper, John D.; Clark, David; Riddell, Andrew D.

doi:10.1016/j.pathol.2022.06.007

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…23 Furthermore, these missing pathology details may have affected the ability to detect significant differences between the 2020 cohort and the 2011-2019 cohort. 23 However, of note, clinicians would have had access to the same quality of pathology reports that was accessible on the QOR. A further limitation is the retrospective nature of data collection, and furthermore individual patient-clinician discussions were also not available for review.…”

Section: Discussionmentioning

confidence: 99%

“…One limitation of this study was the numbers of missing pathology details in the histopathological reports. A quality assurance activity assessing the pathological reporting for malignant polyps has previously been published, documenting how missing pathological details may affect management strategy 23 . Furthermore, these missing pathology details may have affected the ability to detect significant differences between the 2020 cohort and the 2011–2019 cohort 23 .…”

Section: Discussionmentioning

confidence: 99%

“…A quality assurance activity assessing the pathological reporting for malignant polyps has previously been published, documenting how missing pathological details may affect management strategy 23 . Furthermore, these missing pathology details may have affected the ability to detect significant differences between the 2020 cohort and the 2011–2019 cohort 23 . However, of note, clinicians would have had access to the same quality of pathology reports that was accessible on the QOR.…”

Section: Discussionmentioning

confidence: 99%

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Malignant polyps in the COVID‐19 era: a population‐based analysis

Zammit

Brown

Hooper

et al. 2023

ANZ Journal of Surgery

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Background: Malignant polyps represent the early development of colorectal adenocarcinoma. During 2020, there was widescale rationing of health-care resources in response to the COVID-19 pandemic. In particular there was deferral of some colonoscopy procedures required for timely malignant polyp detection. This study sought to assess how these deferrals affected the diagnosis of malignant polyps. Methods: A population wide analysis was performed of 2079 malignant polyps, diagnosed in Queensland, Australia from 2011 to 2020. A regression analysis, with 95% prediction intervals, was produced to determine whether there was a significant impact on the number of malignant polyps diagnosed in 2020 compared to previous years. Univariate statistical analysis of patient, procedural, and pathological variables was also performed. Results: In 2020 there were 211 malignant polyps diagnosed, which was significantly lower than was predicted by the univariate regression analysis (r 2 = 0.85, 95% prediction interval: 255.07-323.91, P < 0.001). These malignant polyps were less likely to be diagnosed in a private setting (P < 0.001), and exhibited significantly less depth of submucosal invasion (P = 0.017). There was no significant difference in the management strategy (polypectomy, resection or trans-anal resection) between 2011 and 2019 and 2020. Conclusion: Because of the significant decrease in the number of malignant polyps, and the natural history of the disease, it is expected that there will be an increase in more advanced colorectal adenocarcinomas presenting in 2021 and beyond. This has implications for healthcare resources, particularly in light of the ongoing strain on health departments as a result of the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Malignant polyps in the COVID‐19 era: a population‐based analysis

Zammit

Brown

Hooper

et al. 2023

ANZ Journal of Surgery

View full text Add to dashboard Cite

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“…However, combination of the comorbidity count with the ASA score and age group for matching purposes, will have provided a fair approximation of a patients premorbid functioning prior to colorectal resection. Missing pathological details may have resulted in some malignant polyps being misclassified into lower risk categories, potentially affecting management choice and thus also potentially impacting survival [24]. Complicating the assessment of survival is the choice in measurement of survival.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the ACPGBI risk categorisation score is the only prognostic scoring system which utilises multiple pathological factors to determine an overall risk score for malignant polyps. Several hypotheses are that the ACPGBI guidelines and recommendations may not be applicable to the study population; large numbers of missing pathological details in pathology reports [24]; and guidelines being based on risks of residual or lymphatic disease rather than impacts on survival. Residual disease or nodal positivity may not be an adequate predictor of long-term recurrence and hence survival, with up to 40% recurrence rate reported for patients with histologically node negative disease [25,26].…”

Section: Discussionmentioning

confidence: 99%

In comparison with polypectomy, colorectal resection is associated with improved survival for patients diagnosed with malignant polyps

et al. 2022

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Aim Patients diagnosed with a malignant polyp generally have favourable overall survival (OS) and cancer‐specific survival (CSS). However, it is unclear how choice in management for malignant polyps may affect survival. Methods Data from the Queensland Oncology Repository was analysed to derive a population wide assessment of the impact of management strategy on OS and CSS for patients diagnosed with malignant polyps. Log‐rank testing, Kaplan–Meier and Cox‐regression models were performed. Patients were matched using propensity score and Mahalanobis distance matching. Results A total of 1,646 patients were included with 240 deaths and 52 colorectal cancer related deaths until censor date. Following propensity score and Mahalanobis distance matching of patients undergoing polypectomy alone versus colorectal resection, there was no significant difference in the age groups (<60 years of age or ≥60 years of age), American Society of Anesthesiology score, comorbidity count or Association of ColoProctology of Great Britain and Ireland risk category. However, of note Log‐rank testing demonstrated a significant difference in OS (p < 0.001) and CSS (p = 0.0061) between management strategies. Multivariable Cox‐regression models in matched and un‐matched patient cohorts demonstrated significantly lower hazards of death for OS with resection (p < 0.001). However, CSS was no longer significantly different between management groups in multivariable Cox‐regression analysis (p = 0.073). Conclusion Patients who underwent colorectal resection had significantly improved OS and CSS compared with polypectomy alone. Improved OS was furthermore seen on multivariable analysis, and in matched cohorts. Future research should investigate why this unexpected finding may be the case and whether updates to guidelines should be considered.

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