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Pathologic Interpretation of Colorectal Polyps in Community Practice

Study reveals poor reproducibility in polyp interpretation by community pathologists, impacting clinical management in CRC screening programs. Recommendations for standardization and surveillance suggested.

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Pathologic Interpretation of Colorectal Polyps in Community Practice

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  1. Assessment of pathologic interpretation of colorectal polyps by general pathologists in community practice Bernard DENIS, Carol PETERS, Catherine CHAPELAIN, Isabelle KLEINCLAUS, Anne FRICKER, Richard WILD, Bernard AUGE, Denis CHATELAIN , Jean François FLEJOU Association pour le dépistage du cancer colorectal dans le Haut-Rhin (ADECA 68) Colmar, France

  2. background • The assessment of type and dysplasia of colorectal polyps is poorly reproducible in clinical practice Demers RY 1990, Jensen P 1995, Rex DK 1999, Yoon H 2002, Costantini M 2003, Komuta K 2004

  3. background • population-based CRC screening program with guaiac based FOBT • Haut-Rhin: • 1 of 23 pilot areas • 190 000 residents aged 50-74 y • May 2006: 2560 polyps / 1274 people

  4. background P<0.001 P<0.001 Rate of adenomas with >20% villous elements. Goal: <10% Recommendations U.S. multi-society task force on CRC. Am J Gastroenterol 2002

  5. aim to assess • performances of community pathologists in the interpretation of colorectal polyps • clinical impact on a population-based FOBT CRC screening program

  6. methods • screening program • 2560 polyps = whole cohort • slides / 14 community pathologists (P1) • study • sample of 300 polyps (11.7%) • all serrated adenomas (n = 71) • all in situ (n = 77) and T1 carcinomas (n = 39) • other polyps selected at random (n = 114) • review • slides / 2 expert GI academic pathologists (P2) • pathology reports of malignant polyps

  7. results – study population

  8. results – study population

  9. results – community pathologists performances

  10. results – community pathologists performances

  11. clinical impact • 2 questions to the pathologist • is the polyp malignant? if yes, is surgery needed? • is colonoscopic surveillance needed? if yes, when? no yes no 5 y 3 y

  12. results – clinical impact

  13. results – clinical impact

  14. results – clinical impact

  15. results – community pathologists performances Bayes formulae PPV =Se x PNPV= Sp x (1 - P) Se x P + (1 - P) x (1 - Sp) Sp x (1 - P) + P x (1 – Se)

  16. results – overall clinical impact

  17. results – pathology reports of malignant polyps

  18. conclusion • poor inter-observer agreement in the pathologic interpretation of colorectal polyps by community pathologists • in the real world, impact on clinical management: 1/4 of cases • frequent lack of adequate characterization of malignant polyps

  19. future • benign polyps • need for a clarification (simplification) of the nomenclature, especially for serrated polyps • surveillance interval for polyps ≥ 10 mm should be 3 years whatever the pathology report may be • malignant polyps • slides should be reviewed by expert pathologists • need for a standardized pathology report

  20. standardized pathology report for malignant polyps • degree of differentiation: …….. • angiolymphatic invasion: ……… • resection margin status: ……… • T stage: ……….

  21. Bernard Auge Catherine Chapelain Anne Fricker Sylvette Itten Isabelle Kleinclaus Sylvie Krzisch Denis Laedlein Carol Peters Martine Prevot Sylvie Rozan Pierre Straub Sylvie Thiebault Marie Claire Tortel Richard Wild acknowledgements

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