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Does the caseload of the pathologist influence the minimum and extended data set of pathology variables reported for
Hatzidis1, Solomon, Schnitzler
1Department of Colon and Rectal Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia, Department of Colon and Rectal Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia, Department of Colon and Rectal Surgery, Nepean Hospital, University of Sydney, Sydney, Australia, Department of Colon and Rectal Surgery, Westmead Hospital, University of Sydney, Sydney, Australia, Department of Colon and Rectal Surgery, Concord Hospital, University of Sydney, Sydney, Australia.
Background:
The role of adjuvant therapy for rectal carcinoma, both radiotherapy and chemotherapy, remains controversial. Nevertheless, some stages of rectal cancer may benefit from adjuvant therapies. Post-operative decision making is determined by accurate pathology staging of the tumour which may depend on the experience, expertise and activity of the pathologist and by surgeon variables.
Methods:
Pathology reports for consecutive rectal cancer resection specimens at five University of Sydney teaching hospitals were assessed for the presence of important pathology variables. The desired minimum data set included the assessment of six major variables: extent of tumour penetration, distal and circumferential margins, degree of differentiation, number of nodes and identification of an apical node. A multivariate analysis was performed to see if the activity of the pathologist (number of specimens reported in time period) correlated with the number of minimum data set pathology variables reported. Multivariate analysis was also used to determine if the activity (number of resections) or training (colorectal society vs non-society) of the surgeon were correlated with variables potentially related to adequate surgical clearance of the tumour and to abdominoperineal (APE) resection rates.
Results:
Four hundred and forty-five consecutive rectal cancer pathology reports were reviewed. Of the minimum data set (six variables) only 17% of the reports documented all of these major variables (range 2-6). Apical node identification was reported in only 47% of reports and circumferential margin in only 39%. Circumferential margin was reported significantly more frequently in the higher activity group of pathologists (51% vs 29%, P=0.00001). APE rates were significantly different between some of the hospitals (range 19-31%). Surgeons performing more than 20 resections had lower APE rates (16% vs 37%, P=0.000 001) than those with less than 20 resections. There was no difference in APE rates between society and non-society surgeons. Distal margins of <2 cm for anterior resections were significantly higher in non-society surgeons (52% vs 36%, P=0.004).
Discussion:
Standardized reporting, template proformas and perhaps dedicated gastrointestinal pathologists may improve reporting of surgical rectal cancer specimens.
