Harmonisation of Colorectal Cancer Pathology Reporting
 | The pathology report represents a summation of the available information on the cancer and is the single most powerful indicator used by clinicians to define prognostic risk and the need for adjuvant therapy. A number of studies have shown that histopathology reports lack reproducibility and do not always include each of the critical items necessary for accurate diagnosis [1, 2]. Both the ability to obtain all relevant information and the ability to adequately interpret and communicate that information are essential elements of a pathology report.
A pathology report must contain a minimum amount of data to allow for accurate classification, interpretation and diagnosis of a colorectal cancer. This minimum data set reflects current knowledge of the disease and is required to be continually updated and refined. The use of synoptic reports and checklists has been promoted as a way of improving pathology reporting for colorectal cancer [3, 4]; however synoptic documents are used variably by institutions. In addition, it is important to recognise that the use of templates does not guarantee the correctness of the responses to each checkbox. Guidelines regarding current diagnostic practices therefore need to be provided in conjunction with synoptic templates. |
For inclusion in a minimum data set the following criteria should be satisfied for each item:
- Independently prognostic or otherwise informative for patient management
- Measurable by specific, defined and agreed on terms
- Easily assessable with minimal intra- or inter-observer variability
By looking at the above criteria an overall idea of the usefulness of an item can be obtained. Clearly an item that is easy to identify and describe, but has no prognostic value, is not particularly useful. Similarly, an item that has been shown to be prognostic is also not particularly useful if it is not able to be consistently described by different pathologists, or if the terms used to describe the item are ambiguous.
In describing a minimum data set, it is essential to include a list of definitions, and it is imperative that the system used to stage the cancer is also listed. Illustrations and examples also lend themselves to a better understanding of the item described.
A
minimum dataset for the reporting of colorectal cancers has been developed by the Colorectal Cancer Research Consortium in collaboration with the Cancer Council NSW, the NSW Oncology Group for Colorectal Cancer and the Cancer Institute NSW.
References
1. Bull, A.D., et al., Colorectal cancer pathology reporting: a regional audit. Journal of Clinical Pathology, 1997. 50(2): p. 138-42.
2. Cross, S.S., K.M. Feeley, and C.A. Angel, The effect of four interventions on the informational content of histopathology reports of resected colorectal carcinomas. Journal of Clinical Pathology, 1998. 51(6): p. 481-2
3. Beattie, G.C., et al., Improvement in quality of colorectal cancer pathology reporting with a standardized proforma--a comparative study. Colorectal Disease, 2003. 5(6): p. 558-62.
4. Branston, L.K., et al., The implementation of guidelines and computerised forms improves the completeness of cancer pathology reporting. The CROPS project: a randomised controlled trial in pathology. European Journal of Cancer, 2002. 38(6): p. 764-72.