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The effect of four interventions on the informational content of histopathology reports of resected colorectal carcinomas. Cross SS, Feeley KM, Angel CA. free text with no agreed guidelines text guidelines template proformas

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  1. The effect of four interventions on the informational content of histopathologyreports of resected colorectal carcinomas.Cross SS, Feeley KM, Angel CA. • free text with no agreed guidelines • text guidelines • template proformas • All interventions produced some increase in inclusion rate for some features, but only with the introduction of template proformas did these rates approach 100% for all data items. Inclusion rates were 100% for all items in all cases reported using a proforma. J Clin Pathol 1998;51:481-2

  2. Criterio guida PRATICABILITA’ > CORRETTEZZA FORMALE • Studio multicentrico che non prevede una centralizzazione delle attività di preparazione e refertazione • Studio spontaneo che non prevede al momento risorse aggiuntive

  3. RADIALINVASION and SURGICAL CLEARANCE IN RECTAL CANCER

  4. RECTAL CANCER: SURVIVAL AND PRESENCE OF TUMOR AT CIRCUMFERENTIAL RESECTION MARGIN (CRM) 1.0 0.8 CRM -ve 106 pts 0.6 cumulative proportion surviving 0.4 CRM +ve 35 pts 0.2 All patients underwent potentially curative resection 0.0 1 2 3 4 5 years after surgery Adam et al Lancet 1994; 344:707

  5. Am J Surg Pathol 26, 350-7: 2002

  6. Circumferential Margin Involvement Am J Surg Pathol 26, 350-7: 2002

  7. Valutazione tumore residuo Rx: presenza di tumore residuo non valutabile R0: assenza di tumore residuo diagnosticabile (considera la situazione obiettiva dopo l’intervento; ad es. un paziente con metastasi a distanza rimosse radicalmente appartiene al IV stadio ma la resezione è R0). R1: Presenza di neoplasia microscopica. A questa categoria appartengono anche quei pazienti il cui lavaggio peritoneale, appena dopo la laparotomia, è positivo per cellule neoplastiche anche se la resezione della neoplasia risulta poi curativa. R2: Presenza di neoplasia residua macroscopica

  8. Chemotherapy response scoring - Dworak • Grade 0 No regression • Grade 1 Minimal regression: dominant tumor mass, obvious fibrosis and/or vasculopathy • Grade 2 Moderate regression: dominantly fibrotic changes, few tumor cells or groups (easy to find) • Grade 3 Good regression: very few (difficult to find) tumor cells in fibrotic tissue with or without mucin • Grade 4 Total regression: no tumor cells, only fibrotic mass or mucin • Poor response = grade 0-2 • Good response = grade 3-4

  9. A small vein with venous invasion, not identified by H+E stain alone, but clearly demonstrated after the addition of an elastic fibre stain

  10. Conclusions from a study of venous invasion instage IV colorectal adenocarcinoma A Sternberg, M Amar, R Alfici and G Groisman Journal of Clinical Pathology 2002;55:17-21 The addition of an elastic fibre stain enables the identification of venous invasion in a large proportion of colorectal carcinomas that are falsely negative on haematoxylin and eosin alone It is probable that only minimal venous invasion is needed to seed clinically important distant metastases Both extramural and intramural venous invasion may seed clinically important haematogenous metastases

  11. Good/complete Moderate From P. Quirke (Core Study) Incomplete

  12. Valutazione dell’escissione del mesoretto ottimo: il mesoretto è intatto o presenta solo irregolarità minori della fascia propria del retto (liscio, lucente). Le irregolarità non devono superare i 5mm, non deve esserci “conizzazione” del mesoretto. moderato: irregolarità della superficie della fascia propria del retto (> a 5mm), conizzazione moderata. In nessun punto viene visualizzata la muscolare propria tranne che nel punto di inserzione dei muscoli elevatori. Sulle fette di 3-5 mm si visualizzano solo irregolarità moderate del margine circonferenziale. scarso: evidenti difetti del mesoretto con esposizione della muscolare propria e /o accentuata irregolarità del margine circonferenziale alla sezione.

  13. Histopathological detection of lymph nodemetastases from colorectal carcinomaJ Clin Pathol 2000; 53:685-687 72 colorectal carcinoma resection specimens Lymph nodes up to approximately 5 mm in maximum extent were processed in entirety, without prior sectioning, and assessed histologically at three levels In one case, this led to the detection of the only nodal metastasis present and therefore "upstaged" the tumour from Dukes's B to C The assessment of multiple sections of lymph nodes from colorectal specimens leads to the detection of only a small number of additional nodal metastases. The method involves increased workload for pathologists and laboratory staff.

  14. SCHEDA di VALUTAZIONE ANATOMOPATOLOGICA destro sinistro 

  15. SCHEDA di VALUTAZIONE ANATOMOPATOLOGICA

  16. V0ƀ V1ƀ V2ƀ

  17. Criteri obbligatori • T, N, M • Margine radiale (<1mm) • Invasione venosa (intra o extra-murale) • Tumore residuo (R) • Risposta al trattamento (Dworak)

  18. Metodiche obbligatorie • Compilazione scheda istologica • Esame microscopico di tutta l’area tumorale, >3 blocchetti (T, N, M) • Esame microscopico margine R, >1 blocchetto (Margine radiale) • Colorazione elastiche (Invasione venosa) • Un blocchetto extra per indagini successive (tumore+mucosa) • Da scegliere all’atto della diagnosi • Anche dei casi regressione completa • Centralizzare

  19. Metodiche facoltative • Qualità del mesoretto (documentazione fotografica) • Macrosezioni • Peeling margine radiale • Ricerca micrometastasi (IHC/rtPCR)

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