Standardized Pathology Report Research Articles

Patient-centered pathology reports for breast cancer care: Interim results of a randomized pilot study.

e19157 Background: Receiving a new cancer diagnosis event is a daunting event, quickly followed by complex decision-making between patients and care teams. In order for patients to fully engage in shared decision-making with their providers, they must have access to understandable, patient-centered information that empowers them to take an active role. Yet cancer pathology reports currently target providers and are marred by complex medical terminology. To address this gap, we designed and piloted patient-centered pathology reports (PCPRs) for breast cancer surgical pathology. We hypothesized that PCPRs would result in patients having greater pathology knowledge and decisional self-efficacy. Methods: PCPRs were designed with continuous guidance from breast surgeons, pathologists, and patient advocates with the goal of providing a supplemental tool to translate standard pathology reports to layman’s terms for patients. PCPRs were built into the electronic medical record and tested for quality and accuracy over a 4-month period. Participants were recruited from the clinical practices of two breast surgeons and randomized to receive either the PCPR and standard pathology report or standard pathology report alone. Patients were surveyed at baseline and one month after to assess their breast cancer knowledge and ratings of confidence (scale 1-5) and decisional self-efficacy (DSE) for treatment decision-making (scale 0-100). Results: Of a planned 40 pilot patients, 30 have been enrolled, randomized (20 standard report patients, 10 PCPR patients), and have follow up data. Evaluation of patient knowledge showed that compared with the control group, patients who received a PCPR had similar knowledge of the important elements of their report (p = 0.10-p = 0.69) with greater specificity for those report elements. Confidence in their diagnosis slightly favored PCPR recipients (confidence rating mean 4.00 vs. 3.77 for control patients, p = 0.67). Patients receiving the PCPR had better DSE immediately after receipt of the pathology report than standard report patients (DSE 96.0 vs. 82.2, respectively, p = 0.05) with a more attenuated DSE difference one month later (DSE 87.3 vs. 79.2, respectively, p = 0.35). Conclusions: This interim analysis suggests that providing breast cancer patients with patient-centered pathology reports may contribute to an improved ability to engage in shared decision-making. Confirming these results with complete pilot data could inform a larger multicenter study to validate their effectiveness in clinical cancer care.

Standardized Pathology Report for Colorectal Cancer, 2nd Edition.

The first edition of the ‘Standardized Pathology Report for Colorectal Cancer,’ which was developed by the Gastrointestinal Pathology Study Group (GIP) of the Korean Society of Pathologists, was published 13 years ago. Meanwhile, there have been many changes in the pathologic diagnosis of colorectal cancer (CRC), pathologic findings included in the pathology report, and immunohistochemical and molecular pathology required for the diagnosis and treatment of colorectal cancer. In order to reflect these changes, we (GIP) decided to make the second edition of the report. The purpose of this standardized pathology report is to provide a practical protocol for Korean pathologists, which could help diagnose and treat CRC patients. This report consists of “standard data elements” and “conditional data elements.” Basic pathologic findings and parts necessary for prognostication of CRC patients are classified as “standard data elements,” while other prognostic factors and factors related to adjuvant therapy are classified as “conditional data elements” so that each institution could select the contents according to the characteristics of the institution. The Korean version is also provided separately so that Korean pathologists can easily understand and use this report. We hope that this report will be helpful in the daily practice of CRC diagnosis.

Identification of barriers and facilitators in nationwide implementation of standardized structured reporting in pathology: a mixed method study

Standardized structured reporting (SSR) enables high-quality pathology reporting, but implementing SSR is slow. The objective of this study is to identify both barriers and facilitators that pathologists encounter in SSR, in order to develop tailored implementation tools to increase SSR usage. We used a mixed method design: a focus group interview helped to identify barriers and facilitators in SSR. The findings were classified into the following domains: innovation, individual professional, social setting, organization, and economic and political context. We used a web-based survey among Dutch pathologists to quantify the findings. Ten pathologists participated in the focus group interview, and 97 pathologists completed the survey. The results of both showed that pathologists perceive barriers related to SSR itself. Particularly its incompatibility caused lack of nuance (73%, n = 97) in the standardized structured pathology report. Regarding the individual professional, knowledge about available SSR-templates was lacking (28%, n = 97), and only 44% (n = 94) of the respondents agreed that using SSR facilitates the most accurate diagnosis. Related to social setting, support from the multidisciplinary team members was lacking (45%, n = 94). At organization level, SSR leads to extra work (52%, n = 94) because of its incompatibility with other information systems (38%, n = 93). Main facilitators of SSR were incorporation of speech recognition (54%, n = 94) and improvement in communication during multidisciplinary team meetings (69%, n = 94). Both barriers and facilitators existed in various domains. These factors can be used to develop implementation tools to encourage SSR usage.

Evaluation of Structure Indicators for Assessing Skin Cancer Quality of Care in Dermatology Departments

Introduction and objectivesA series of quality indicators for melanoma and nonmelanoma skin cancer were recently approved within a project promoted by the Healthy Skin Foundation of the Spanish AEDV. The aim of this study was to evaluate adherence to these indicators. Material and methodsIn November 2016, an anonymous questionnaire consisting of 32 items was sent to the heads of Spanish dermatology and venereology departments listed in the AEDV's database. The questions referred to the above-mentioned quality of care indicators. ResultsThe questionnaire was completed by 104 of the 150 people contacted (response rate, 69.3%). The lowest response rate for any given question was 56% (84 respondents). Over 85% of respondents answered 29 questions or more (91%). The most widely used indicators were those related to the use of computed tomography or magnetic resonance imaging for squamous cell carcinoma (98%), followed by the availability of a standardized melanoma pathology report (90%). The least widely used indicators were related to availability of electrochemotherapy (25%) and other invasive therapies for locoregionally advanced melanoma (20%). ConclusionsAdherence to quality of cancer care criteria at the different hospitals evaluated varied. Our findings could be useful for identifying areas for improvement at different hospitals. Future studies should focus on measuring both process and outcome indicators.

Evaluación de indicadores de estructura en la atención al paciente con cáncer de piel en los servicios de dermatología

Introduction and objectivesA series of quality indicators for melanoma and nonmelanoma skin cancer were recently approved within a project promoted by the Healthy Skin Foundation of the Spanish AEDV. The aim of this study was to evaluate adherence to these indicators. Material and methodsIn November 2016, an anonymous questionnaire consisting of 32 items was sent to the heads of Spanish dermatology and venereology departments listed in the AEDV's database. The questions referred to the above-mentioned quality of care indicators. ResultsThe questionnaire was completed by 104 of the 150 people contacted (response rate, 69.3%). The lowest response rate for any given question was 56% (84 respondents). Over 85% of respondents answered 29 questions or more (91%). The most widely used indicators were those related to the use of computed tomography or magnetic resonance imaging for squamous cell carcinoma (98%), followed by the availability of a standardized melanoma pathology report (90%). The least widely used indicators were related to availability of electrochemotherapy (25%) and other invasive therapies for locoregionally advanced melanoma (20%). ConclusionsAdherence to quality of cancer care criteria at the different hospitals evaluated varied. Our findings could be useful for identifying areas for improvement at different hospitals. Future studies should focus on measuring both process and outcome indicators.

MP31-13 COMPARATIVE EFFECTIVENESS OF A PATIENT CENTERED PATHOLOGY REPORT FOR BLADDER CANCER CARE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III1 Apr 2016MP31-13 COMPARATIVE EFFECTIVENESS OF A PATIENT CENTERED PATHOLOGY REPORT FOR BLADDER CANCER CARE Matthew Mossanen, Liam Macleod, Alice Chu, Jonathan L. Wright, Daniel W. Lin, Bruce Dalkin, Lawrence True, and John L. Gore Matthew MossanenMatthew Mossanen More articles by this author , Liam MacleodLiam Macleod More articles by this author , Alice ChuAlice Chu More articles by this author , Jonathan L. WrightJonathan L. Wright More articles by this author , Daniel W. LinDaniel W. Lin More articles by this author , Bruce DalkinBruce Dalkin More articles by this author , Lawrence TrueLawrence True More articles by this author , and John L. GoreJohn L. Gore More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1266AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Through Meaningful Use Criteria, patients will have unprecedented access to their medical records including pathology reports. However, patients are not considered the primary audience of pathology reports and the average report is written beyond the health literacy of the average patient. We compared the effectiveness of a patient-centered version of bladder biopsy pathology reports derived from patient-centered outcomes research methods with standard pathology reports. METHODS Local bladder cancer experts provided consensus on the important elements of a bladder biopsy pathology report for conveying prognosis and informing patient counseling. Patient focus groups reviewed these elements and identified patient-centered formats and language. Candidate reports were iterated with patients to arrive at a pilot patient-centered bladder biopsy report. We recruited patients undergoing bladder biopsy for suspicion of initial or recurrent bladder cancer and enrolled 40 patients. Block randomization was performed to either the standard report or the standard report and the pilot patient-centered pathology report (PCPR). Through web-based surveys, we assessed self-efficacy with the PEPPI (Perceived Efficacy in Patient-Physician Interactions, max score 25, higher scores indicating greater self-efficacy), physician communication with the CAT (Communication Assessment Tool, reported as proportion reporting “excellent” on 15 response items), knowledge based on comprehension of the pathology report elements prioritized by experts, and format preferences at pathology disclosure and one month later. We compared study groups with descriptive statistics. RESULTS The 26-member expert clinician panel identified stage, grade, and histology as the most important elements of a bladder biopsy pathology report. Patients prioritized data expressed in a narrative format, an illustration of tumor stage, and risk stratification for future recurrence. From July 2014 to June 2015, 39 patients completed initial and follow-up assessments. Patients that received the PCPR had an improved ability to identify their cancer stage (initial assessment 58% vs. 20%, p=0.02; follow-up assessment 47% vs. 15%, p=0.03) and trended toward improved identification of cancer grade (initial assessment 74% vs. 50%, p=0.12) compared with patients that only received the standard report. Ratings of patient self-efficacy were uniformly high and did not differ by report format. Provider communication trended toward improved communication among patients exposed to PCPR. CONCLUSIONS PCPR are associated with greater patient knowledge about their new cancer diagnosis and may aid with patient-provider communication around a new cancer diagnosis. While these results require validation in a larger cohort, this pilot may serve as a model for development of PCPR for other cancers. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e424 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Matthew Mossanen More articles by this author Liam Macleod More articles by this author Alice Chu More articles by this author Jonathan L. Wright More articles by this author Daniel W. Lin More articles by this author Bruce Dalkin More articles by this author Lawrence True More articles by this author John L. Gore More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation of Lymph Node Density With Negative Outcome Predictors in Oral and Maxillofacial Squamous Cell Carcinoma

Lymph node density is defined as the number of positive lymph nodes per total number of excised lymph nodes. In oral and maxillofacial cancer, there are recent data showing that increased lymph node density leads to worse outcomes for patients. However, data correlating lymph node density with other known risk parameters are lacking. This study investigated whether a direct correlation exists among cervical lymph node density, depth of invasion, perineural invasion, and extracapsular tumor spread. A retrospective chart review was undertaken to include all patients who underwent neck dissection with resection of primary oral and maxillofacial squamous cell carcinoma from January 2009 through July 2014. After applying the exclusion criteria, 286 patients were identified. Primary tumor depth of invasion, perineural invasion, and lymph node status, including extracapsular spread, were obtained from the standard pathology report. Descriptive statistics were applied. The association between 2 continuous tumor characteristics was summarized with the Pearson correlation coefficient, and the association between a continuous and a binary tumor characteristic was summarized with 2-sample t test. Statistical significance for the study was set at a P value less than .05. Mean age at time of surgery was 63.9 ± 12.5years. The final study included 169 men and 117 women (N= 286). The mean depth of invasion was 12.3 ± 11mm (range, 1 to 69mm). Mean lymph node density was 0.04 ± 0.1 (range, 0 to 0.81). There was a positive association between lymph node density and depth of tumor invasion (Pearson correlation coefficient, r= 0.21; P < .001). Tumors with perineural invasion had a statistically significant difference in mean lymph node density (0.074 for positive vs 0.024 for negative; P < .001). There also was a significant association in mean lymph node density with the presence of extracapsular spread (0.143 for positive and 0.010 for negative; P < .001). Statistically relevant positive linear relations among lymph node density, depth of invasion, perineural invasion, and extracapsular spread were identified. Lymph node density could have prognostic implications, because it is statistically correlated with other known prognostic features that lead to poor outcomes. Lymph node density could be an important feature to capture in future prospective trials. Pathology standards would be crucial in this endeavor.

Comparative effectiveness of a patient centered pathology report for bladder cancer care.

420 Background: We compared the effectiveness of a patient-centered (PC) version of bladder biopsy pathology reports derived from PC outcomes research methods with standard pathology reports. Methods: Local bladder cancer experts provided consensus on the important elements of a bladder biopsy pathology. Patient focus groups reviewed these elements and identified PC formats and language. Candidate reports were iterated with patients to arrive at a pilot PC bladder biopsy report. We enrolled 40 patients undergoing bladder biopsy for suspicion of initial or recurrent bladder cancer. Block randomization was performed to the standard report or the standard report and the pilot patient-centered pathology report (PCPR). Through web-based surveys, we assessed self-efficacy with the PEPPI (Perceived Efficacy in Patient-Physician Interactions), physician communication with the CAT (Communication Assessment Tool), knowledge based on comprehension of report elements prioritized by experts, and format preferences at pathology disclosure and one month later. We compared study groups with descriptive statistics. Results: The 26-member expert clinician panel identified stage, grade, and histology as the most important elements of a pathology report. Patients prioritized data expressed in a narrative format, an illustration of tumor stage, and risk stratification for future recurrence. From July 2014 to 2015, 39 patients completed initial and follow-up assessments. Patients that received the PCPR had an improved ability to identify their cancer stage (initial 58% vs 20%, p = 0.02; follow-up 47% vs 15%, p = 0.03) and trended toward improved identification of cancer grade (initial 74% vs 50%, p = 0.12) compared with patients that only received standard reports. Ratings of patient self-efficacy did not differ by report format and communication trended toward improved communication for patients exposed to PCPR. Conclusions: PCPR are associated with greater patient knowledge about their new cancer diagnosis and may aid patient-provider communication around a new cancer diagnosis. While these results require validation in larger cohorts, this pilot may serve as a model for the development of PCPR for other cancers.

The Role of Pathology Correlation Approach in Prostate Cancer Index Lesion Detection and Quantitative Analysis with Multiparametric MRI

Rationale and ObjectivesDevelopment of imaging biomarkers often relies on their correlation with histopathology. Our aim was to compare two approaches for correlating pathology to multiparametric magnetic resonance (MR) imaging (mpMRI) for localization and quantitative assessment of prostate cancer (PCa) index tumor using whole mount (WM) pathology (WMP) as the reference.Materials and MethodsPatients (N = 30) underwent mpMRI that included diffusion-weighted imaging and dynamic contrast-enhanced (DCE) MRI at 3 T before radical prostatectomy (RP). RP specimens were processed using WM technique (WMP) and findings summarized in a standard surgical pathology report (SPR). Histology index tumor volumes (HTVs) were compared to MR tumor volumes (MRTVs) using two approaches for index lesion identification on mpMRI using annotated WMP slides as the reference (WMP) and using routine SPR as the reference. Consistency of index tumor localization, tumor volume, and mean values of the derived quantitative parameters (mean apparent diffusion coefficient [ADC], Ktrans, and ve) were compared.ResultsIndex lesions from 16 of 30 patients met the selection criteria. There was WMP/SRP agreement in index tumor in 13 of 16 patients. ADC-based MRTVs were larger (P < .05) than DCE-based MRTVs. ADC MRTVs were smaller than HTV (P < .005). There was a strong correlation between HTV and MRTV (Pearson r > 0.8; P < .05). No significant differences were observed in the mean values of Ktrans and ADC between the WMP and SPR.ConclusionsWMP correlation is superior to SPR for accurate localization of all index lesions. The use of WMP is however not required to distinguish significant differences of mean values of quantitative MRI parameters within tumor volume.

Colorectal cancer: Standardized pathology report in 2014

Le compte rendu anatomopathologique du cancer colorectal (CCR) est un element essentiel pour etayer un traitement personnalise en 2014, qu’il s’agisse de cancer localise, localement avance ou metastatique. Il repose sur des criteres macroscopiques, histologiques, immunohistochimiques et moleculaires, et s’appuie sur les dernieres versions des classifications Tumor Node Metastase/Union for International Cancer Control (TNM/UICC) et Organisation mondiale de la sante (OMS). Les parametres y figurant peuvent etre pronostiques ou predictifs. Ils doivent etre lisibles et facilement interpretables pour une utilisation optimale en reunion de concertation pluridisciplinaire. Le compte rendu type peut beneficier d’une forme standardisee, a l’instar des formulaires proposes par la Societe francaise de pathologie (SFP) et l’Institut national du cancer (INCa). Cet article a pour but de presenter et d’argumenter les items structurant le compte rendu anatomopathologique type du CCR, a la lumiere des donnees de la litterature disponibles en 2014.

DNA methylation at imprint regulatory regions in preterm birth and infection

To aid in understanding long-term health consequences of intrauterine infections in preterm birth, we evaluated DNA methylation at 9 differentially methylated regions that regulate imprinted genes by type of preterm birth (spontaneous preterm labor, preterm premature rupture of membranes, or medically indicated [fetal growth restriction and preeclampsia]) and infection status (chorioamnionitis or funisitis). Data on type of preterm birth and infection status were abstracted from medical records and standardized pathology reports in 73 preterm infants enrolled in the Newborn Epigenetics STudy, a prospective cohort study of mother-infant dyads in Durham, NC. Cord blood was collected at birth, and infant DNA methylation levels at the H19, IGF2, MEG3, MEST, SGCE/PEG10, PEG3, NNAT, and PLAGL1 differentially methylated regions were measured using bisulfite pyrosequencing. One-way analyses of variance and logistic regression models were used to compare DNA methylation levels by type of preterm birth and infection status. DNA methylation levels did not differ at any of the regions (P > .20) between infants born via spontaneous preterm labor (average n = 29), preterm premature rupture of membranes (average n = 17), or medically indicated preterm birth (average n = 40). Levels were significantly increased at PLAGL1 in infants with chorioamnionitis (n = 10, 64.4%) compared with infants without chorioamnionitis (n = 63, 57.9%), P < .01. DNA methylation levels were also increased at PLAGL1 for infants with funisitis (n = 7, 63.3%) compared with infants without funisitis (n = 66, 58.3%), P < .05. Dysregulation of PLAGL1 has been associated with abnormal development and cancer. Early-life exposures, including infection/inflammation, may affect epigenetic changes that increase susceptibility to later chronic disease.

Pathology Reporting of Neuroendocrine Tumors: Essential Elements for Accurate Diagnosis, Classification, and Staging

Much recent debate has focused on the optimal classification of epithelial neuroendocrine tumors (NETs). Multiple different systems of terminology, grading, and staging have been proposed, and some systems combine elements of grade and stage into a single prognostic classification. Recently, national and international consensus groups have attempted to standardize the classification of NETs, especially for those arising in the gastrointestinal tract and pancreas. Furthermore, the recognition that common classification criteria (such as proliferative rate) span multiple different systems allows the basic data necessary to predict outcome and tailor therapy to be included in pathology reports, even though a single uniform system of terminology may remain elusive. Formal tumor-node-metastasis (TNM)-based staging systems also have been developed recently, and advances in the treatment of some NETs (pancreatic in particular) are pointing towards the need to assess therapeutic biomarkers in routine practice. This review will present the most widely used systems for classifying, grading, and staging NETs and will summarize the recommendations for the data to be included in standard pathology reports of these uncommon tumors.

Proposal for a Standardized Pathology Report of Gastroenteropancreatic Neuroendocrine Tumors: Prognostic Significance of Pathological Parameters

BackgroundThere is confusion in the diagnosis and biological behaviors of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), because of independently proposed nomenclatures and classifications. A standardized form of pathology report is required for the proper management of patients.MethodsWe discussed the proper pathological evaluation of GEP-NET at the consensus conference of the subcommittee meeting for the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. We then verified the prognostic significance of pathological parameters from our previous nationwide collection of pathological data from 28 hospitals in Korea to determine the essential data set for a pathology report.ResultsHistological classification, grading (mitosis and/or Ki-67 labeling index), T staging (extent, size), lymph node metastasis, and lymphovascular and perineural invasion were significant prognostic factors and essential for the pathology report of GEP-NET, while immunostaining such as synaptophysin and chromogranin may be optional. Furthermore, the staging system, either that of the 2010 American Joint Cancer Committee (AJCC) or the European Neuroendocrine Tumor Society (ENETS), should be specified, especially for pancreatic neuroendocrine neoplasms.ConclusionsA standardized pathology report is crucial for the proper management and prediction of prognosis of patients with GEP-NET.

Is a “Merkel” Just Like a Melanoma? The Pathologic Analysis of Merkel Cell Carcinoma Specimens

I remember being presented my first pathology report for a patient with Merkel cell carcinoma (MCC). What caught my attention the most was the absolute lack of detail in the report, which was generated from a leading academic medical center. Were treatment decisions really being made on such rudimentary variables, such as tumor diameter? At the time, however, a busy clinic and the multiple obligations of a surgical fellow pushed the thoughts to the back of my head. Yet that experience was brought back to the forefront of my mind once again only a few days later when our internal review of that Merkel cell cancer specimen was completed. I was now staring at a pathology report with a wealth of descriptive information similar to what a standard melanoma pathology report would include: tumor thickness, ulceration, mitotic count, etc. Now I was thoroughly engaged because I was completely confused––what was the important primary tumor data that a clinician should use to make subsequent treatment recommendations in this rare cutaneous malignancy? Do the same variables that are associated with outcomes in melanoma apply a priori to MCC? The idea seems logical enough, given that they are both ‘‘skin cancers.’’ However, there also are many differences (cell of origin, growth pattern, proliferative index/growth rate, etc.) that might make using the melanoma prognostic factors to risk stratify MCC, such as placing the proverbial ‘‘square peg in a round hole’’; it is entirely possible that the most significant similarity between melanoma and MCC is that they both start with ‘‘m.’’ In melanoma, the American Joint Committee on Cancer (AJCC) stage classification and determination of the prognostic significance of tumor thickness, mitotic rate, and ulceration is based on an exhaustive analysis of more than 30,000 patients with stage1–3 melanoma with excellent clinical, pathologic, and follow-up data. In contrast, the AJCC staging system in MCC is based on a populationbased analysis (utilizing data from the National Cancer Database [NCDB]) of 5,823 patients. However, unlike the melanoma dataset, the NCDB data is quite limited. For example, detailed pathology data and long-term follow-up are missing. Also, cause of death is not recorded, and thus it is not possible to determine associations between clinical and pathologic variables and death from MCC. In rare diseases like MCC, where large, prospective, randomized, clinical trials will almost certainly never occur, detailed reports of natural history provide excellent insight into the disease and form the best foundation to guide treatment recommendations. Our 2010 report on 412 patients represents the largest single-institution experience in MCC. Although this analysis provides a comprehensive analysis (similar to the AJCC melanoma database) of the natural history of MCC at a tertiary referral center, it is still limited by the rarity of the disease and the biases of any single-institution study. For example, as a stand-alone cancer center, we did not have a large number of immunosuppressed solid organ transplant patients with MCC in our data set, which differs from many other single-institution series of MCC. Despite these limitations, strong attention to detail in data collection and excellent follow-up in some single-institution series represent the best strategy to study patients with rare diseases, such as MCC. For example, we clearly Editorial regarding ‘‘Increasing tumor thickness is associated with more frequent recurrence and poorer survival in Merkel cell carcinoma patients,’’ by Lim & Thompson, et al. (Manuscript ID ASO-2011-12-2319.R1).

An Update on Celiac Disease Histopathology and the Road Ahead

Celiac disease (CD) is a common immune-mediated disorder that occurs in genetically predisposed individuals (carriers of HLA-DQ2 and DQ8 haplotypes) on consumption of wheat (gluten). It is characterized by inflammation of the small-intestinal mucosa and myriad gastrointestinal and systemic manifestations. Celiac disease is common in the general population (prevalence, 0.5%-1%). Currently, small-bowel biopsy is considered the gold standard for diagnosing CD. However, the role of serologic testing in the diagnosis of CD has evolved, from being a supportive test to supplanting intestinal biopsies in certain patient populations. To summarize key aspects of histopathologic assessment, discuss the benefit of standardized pathology reports, impact of the site and number of small-bowel biopsy samples on diagnosis, and recommendations regarding serologic testing. Literature review of publications on CD and experience with histopathologic review of biopsies at the Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, New York. Intraepithelial lymphocytosis in the context of villous atrophy is considered a characteristic histologic finding of CD; however, it is a rather nonspecific finding. A growing list of publications has also indicated that the detection of intraepithelial lymphocytosis in the absence of villous atrophy has rather low specificity for CD. Therefore, communication between pathologists and gastroenterologists is paramount, as is knowledge regarding the pertinent clinical and laboratory data, in distinguishing between CD and other disorders with similar histopathologic and clinical manifestations.

Meta-analysis of Histopathological Features of Primary Colorectal Cancers that Predict Lymph Node Metastases

BackgroundTreatment decisions for colorectal cancer vary based on lymph node status. While some histopathological features of the primary tumor correlate with lymph node spread, the relative influences of these risk factors are not well quantified. ObjectiveThis study aims to systematically review published studies relating histopathological features of primary colorectal cancer to the presence of lymph node metastases and to determine how reliable certain factors might be at predicting nodal metastasis when only the primary lesion is available for study. Data SourcesInclusive literature search using EMBASE and Ovid MEDLINE databases plus manual reference checks of all articles correlating lymphatic spread with colorectal cancer (any T stage) from 1984 to mid-2008 was performed. Study SelectionThis search generated two levels of screening utilized on 602 citations, yielding 123 articles for full review. Data reported from 76 articles were chosen. Main Outcome MeasuresThe relative influence of each histopathological feature on the likelihood of lymphatic metastases was determined. Fixed-effects meta-analysis was performed, and results were reported as Mantel–Haenszel odds ratios (OR). ResultsOf 42 histopathological features analyzed, only 40.4% were reported in >2 articles. The positive predictive values for the top quartile of most frequently reported risk factors were 25.5–86.4%. Among the commonly reported histopathological findings, lymphatic invasion (OR, 8.62) significantly outperformed tumor depth (T2 vs. T1; OR, 2.62) and overall differentiation (OR, 2.38) in predicting nodal spread. For the rectal cancer subset, risk factors differed from the overall colorectal group in predictive ability; poor differentiation at the invasive front (OR, 6.08) and tumor budding (OR, 5.82) were the most predictive. LimitationsThis literature search is limited by the small number of studies examining only rectal cancers and the potential changes in histological and/or surgical techniques over the study period. ConclusionsNo single histopathological feature of colorectal cancer reliably predicted lymph node metastases. Several risk factors that correlate highly with nodal disease are not routine components of standard pathology reports. Until further research establishes histopathological or molecular patterns for predicting lymph node spread, caution should be exercised when basing treatment decisions solely on these factors.

Assessment of pathology reports on hilar cholangiocarcinoma: The results of a nationwide, multicenter survey performed by the AFC-HC-2009 study group

To assess the accuracy of pathology reports in patients operated on for hilar cholangiocarcinoma. Pathology reports for 263 patients operated on in 22 tertiary hepatobiliary centers were reviewed. The report format, turnaround time, tissue specimens, intraoperative consultations, macroscopic and microscopic descriptions, and conclusions were assessed. Surgeons provided pathologists with pertinent clinical and imaging data in only 14% of cases and gave information on specimen orientation in only 24% of cases. The reports frequently failed to give information on prognostic histological factors: tumor differentiation (missing in 27% of cases), vascular invasion (45%), tumor thickness (99%), and infiltration of the bile duct surgical margins (4%). Distances between the tumor and the vessel margin, liver margin and the periductal soft tissue circumferential margin were not specified in 87%, 79%, and 89% of cases, respectively. Only 21% of the reports gave the pTNM stage in the conclusion section. A lack of information prevented retrospective pTNM staging in 48% of cases. Three percent of the reports had discrepancies in their conclusion section. Our French, nationwide study revealed that pathology reports on hilar cholangiocarcinoma frequently lack important information on the main prognostic histological factors and pTNM staging. We recommend the use of a standardized pathology report in this context.

How to read a pathology report of a bone tumor

The interpretation of a biopsy specimen involving bone is one of the most challenging feats for a pathologist, as it is often difficult to distinguish between benign or reactive lesions and malignant tumors on microscopic analysis. Therefore, correlation with the clinical data and imaging is essential and sometimes it is only the evolution of certain characteristics over time or information garnered from molecular analysis that can provide an accurate diagnosis. The pathology report is critical in that it will define subsequent patient management; its wording must precisely reflect those elements that are known with certainty and those that are diagnostic hypotheses. It must be systematic, thorough, and complete and should not be limited to a simple conclusion. The pathologist must first ensure the completeness and correct transcription of the information provided with the specimen, then describe and analyze the histology as well as the quality and representative nature of the sample (as they relate to the radiographic findings and preliminary/final diagnoses), and finally, compare what is seen under the microscope with the assessment made by the radiologist and/or surgeon.This analysis helps to identify difficult cases requiring further consultation between the radiologist and pathologist.There are multiple reasons for misinterpretation of a pathology report. An important and largely underestimated reason is varied interpretations of terms used by the pathologist. Standardized pathology reports with concise phrases as well as multidisciplinary meetings may limit errors and should be encouraged for optimal diagnostic accuracy.

Melanoma histopathology report: proposal for a standardized terminology

Dear Editor, Pathology diagnosis is the end result of a complicated and highly sophisticated process, which, through interpretation of morphological alterations, generates data required for patient management. It is largely based on the macroscopic and microscopic features, but also considers any other issue, from clinical history and physical examination, through laboratory and radiological findings, to pathobiological and therapeutic implications. However, the correct diagnosis at the microscope is not the final step. Pathologists still need to transfer the final diagnosis to the clinicians and to provide information on the nature of the disease and diagnosis consequences, i.e., to release a final pathology report. Often, the report has the form of a narrative text, which largely reflects the personality and attitudes of the reporting pathologist. Thus, identical or similar cases may be diagnosed with significant variations in the content of their reports. This may generate unwonted diversities in the clinical evaluation and therapy. Another drawback of a free text report is the omission of critical information required for the clinical outcome and research purposes. Current medical practice is governed by an evidence-based medicine (EBM) approach. The use of standardized pathology reports, based on checklist compilation, is proposed as a major application of EBM to pathology. Such reports provide the basis for consistent reporting. We have recently surveyed the reporting of melanomas by European pathologists and assessed their current practice and opinions on the information required for the final report, via a web-based questionnaire that was diffused through the members of the Dermatopathology Working Group of the European Society of Pathology. The results of the study indicate that pathology reports for primary cutaneous melanoma vary remarkably among laboratories across Europe [1]. Although the most important prognostic features were reported, some key information which may have an influence on prognosis and treatment were often omitted, while other parameters were inadequately standardized. The objects of the current letter are to present Europewide guidelines for the optimization of the pathology report of skin melanoma and to describe the process that has generated the document through the survey evaluation. A preliminary draft of the proposed melanoma report presented during the business meeting of the Dermatopathology Working Group, which was held in Florence, in September 2009 (22nd European Congress of Pathology). Debates focused on the need for a clear-cut distinction between essential (mandatory to be reported) and desirable (optional to be reported) information and on the terminolA. Batistatou (*) Department of Pathology, University of Ioannina, Medical School, University Campus, 1186, 45110 Ioannina, Greece e-mail: abatista@cc.uoi.gr

Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States

A national conference was held to better characterize the long-term outcomes of liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) and to assess whether it is justified to continue the policy of assigning increased priority for candidates with early-stage HCC on the transplant waiting list in the United States. The objectives of the conference were to address specific HCC issues as they relate to liver allocation, develop a standardized pathology report form for the assessment of the explanted liver, develop more specific imaging criteria for HCC designed to qualify LT candidates for automatic Model for End-Stage Liver Disease (MELD) exception points without the need for biopsy, and develop a standardized pretransplant imaging report form for the assessment of patients with liver lesions. At the completion of the meeting, there was agreement that the allocation policy should result in similar risks of removal from the waiting list and similar transplant rates for HCC and non-HCC candidates. In addition, the allocation policy should select HCC candidates so that there are similar posttransplant outcomes for HCC and non-HCC recipients. There was a general consensus for the development of a calculated continuous HCC priority score for ranking HCC candidates on the list that would incorporate the calculated MELD score, alpha-fetoprotein, tumor size, and rate of tumor growth. Only candidates with at least stage T2 tumors would receive additional HCC priority points.