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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

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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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