AN AUDIT EVALUATING REPORTING OF PT1 COLORECTAL CANCERS AT THE ROYAL DEVON AND EXETER HOSPITAL

IntroductionThe pathology report plays a vital role in assisting the multidisciplinary team to risk stratify colorectal cancers (CRCs). We evaluated our departmental practice of reporting polyp cancers in local resection specimens and suggested appropriate recommendations for quality improvement.MethodsA database search identified patients who had been diagnosed with pT1 CRCs in colonic polyps between March 2014 and December 2018. Gold standards for histologic reporting of specimens were obtained from the Royal College of Pathologists’ minimum data set and NHS Bowel Cancer Screening Programme (NHSBCSP) guidelines. An internal review of pathology reports assessed compliance against these gold standards and the inclusion of newly emerged prognostic parameters.Results70 patients diagnosed with pT1 CRC in colonic polyps were identified during this period. 32.8% of these cases were polyps identified through the Bowel Cancer Screening programme. Two pathologists, as recommended by the NHSBCSP, reported 100% of cases. Tumour differentiation and lymphovascular invasion were reported in over 90% and 80% of cases. 100% of sessile polyps were assigned a Kikuchi level and/or carried a comment to that effect. Haggit level was reported in 86% of pedunculated polyps. In 17% of cases, no comment on the level of submucosal invasion was included. In the majority of these cases (75%), it was deemed difficult to classify the polyps as either pedunculated or sessile, likely due to fragmentation or suboptimal orientation. The depth and width of the invasive tumour, as described by Ueno et al.1, were reported in 47% and 41% respectively. 20% of reports did not mention the distance from the deep margin, 12.8% of the 20% stated this margin was not assessable. The presence or absence of tumour budding was rarely reported (3% of cases).ConclusionsAccurate and consistent reporting of core data items enables clinicians to apply evidence-based clinical judgment when determining patient management and follow-up. Whilst we observed good compliance with reporting standards overall, our study identified key areas of improvement in the current practice. 1. A clear comment on resection margin status (R0/R1) or a comment explaining the variance should be included. 1. Where polyp subtype and depth of invasion are not assessable, the reason should be clarified in the report to avoid confusion. 2. Consistent reporting of depth and width of invasion parameters should be encouraged. More evidence is emerging of their clinical significance and this can be applied to both pedunculated and sessile lesions. 3. Review and amendment of the proforma to include standardised reporting of tumour budding and grading.ReferenceUeno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida A, Hase K, et al. Risk factors for an Adverse Outcome in Early Invasive Colorectal Carcinoma. Gastroenterology. 2004;127:385–394.