Pathology features in Bethesda guidelines predict colorectal cancer microsatellite instability: a population-based study
- Mark A Jenkins 1, Shinichi Hayashi , Anne-Marie O'Shea , Lawrence J Burgart , Tom C Smyrk , David Shimizu , Paul M Waring , Andrew R Ruszkiewicz , Aaron F Pollett , Mark Redston , Melissa A Barker , John A Baron , Graham R Casey , James G Dowty , Graham G Giles , Paul Limburg , Polly Newcomb , Joanne P Young , Michael D Walsh , Stephen N Thibodeau , Noralane M Lindor , Loïc Lemarchand , Steven Gallinger , Robert W Haile , John D Potter , John L Hopper , Jeremy R Jass ,
- 1Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Victoria, Australia. m.jenkins@unimelb.edu.au
- 0Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Victoria, Australia. m.jenkins@unimelb.edu.au
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View abstract on PubMed
Summary
This summary is machine-generated.Pathology features can identify most high microsatellite instability (MSI-H) colorectal cancers in patients under 60. The MsPath score effectively predicts MSI-H probability, reducing unnecessary genetic testing for low-risk cases.
Area Of Science
- Oncology
- Gastroenterology
- Genetics
Background
- Revised Bethesda guidelines suggest MSI testing for colorectal cancer (CRC) in specific age and pathology groups.
- Identifying predictive features for high MSI (MSI-H) is crucial for efficient Lynch syndrome screening.
Purpose Of The Study
- To identify pathology and clinical features that independently predict MSI-high CRC.
- To develop a scoring system (MsPath) for estimating MSI-H probability in CRC patients.
Main Methods
- Analysis of archival tissue from 1098 CRCs diagnosed before age 60.
- MSI testing and collection of pathology features, tumor site, and age at diagnosis.
- Multiple logistic regression to determine independent predictors and develop the MsPath score.
Main Results
- 15% of CRCs were MSI-H. Independent predictors included tumor-infiltrating lymphocytes, proximal subsite, mucinous histology, poor differentiation, Crohn's-like reaction, and diagnosis before age 50.
- The MsPath score demonstrated 93% sensitivity and 55% specificity for MSI-H detection.
Conclusions
- The MsPath score accurately predicts MSI-H probability in CRC.
- Low MsPath scores (<1) suggest minimal benefit from further DNA mismatch repair testing.
- Pathology-based assessment can identify nearly all MSI-H CRCs in patients under 60.
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