The Impact of Knowledge Transfer on the Detection of Venous Invasion in Colorectal Cancer.

Venous invasion (VI) is an independent predictor of hematogenous metastasis and mortality in colorectal cancer (CRC), yet remains widely under-reported. Its detection may require recognition of subtle morphologic clues which at times are only unmasked with an elastin stain. This study evaluates the impact of a knowledge transfer initiative (KTI) on VI detection in a "real world" pathology practice setting. Following participation in an interobserver variability study of VI detection (Kirsch et al 2013), twelve participants received educational materials highlighting key issues in VI detection. Eighteen months later, participants were invited to submit pathology reports from all CRC resections signed-out 18 months prior to and 18 months following the KTI (n=266 and n=244, respectively). Nine pathologists participated. Reports were reviewed for VI and other established prognostic factors. Numbers of elastin stains and tumor-containing blocks were also recorded. Comparative analyses were adjusted for baseline differences in TNM (tumor, lymph node, and metastasis) stage, tumor location, use of neoadjuvant therapy and number of tumor-containing blocks. VI detection increased significantly post-KTI vs. pre-KTI (39.3% vs 18.4%; adjusted odds ratio (OR) 2.86 [1.91-4.28], p<0.001). Increased VI detection post-KTI was observed in both stage II (31.8% vs 12.5%, adjusted OR 3.27 [1.45-7.42], p=0.004) and stage III CRC (62.4% vs 28.2%, adjusted OR 4.23 [2.37-7.55], p<0.001). All pathologists demonstrated increased VI detection post-KTI. Use of elastin stains was significantly higher post-KTI vs. pre-KTI (61.5% vs. 5.3% of cases respectively, p<0.001). This study demonstrates the effectiveness of knowledge transfer in increasing VI detection in routine pathology practice.