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Soegaard Ballester JM, Goodsell KE, Ermer JP, Karakousis GC, Miura JT, Saur NM, Mahmoud NN, Brooks A, Tchou JC, Gabriel PE, Shulman LN, Wachtel H. New Operative Reporting Standards: Where We Stand Now and Opportunities for Innovation. Ann Surg Oncol 2022; 29:1797-1804. [PMID: 34523005 DOI: 10.1245/s10434-021-10766-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American College of Surgeons Commission on Cancer's (CoC) new operative standards for breast cancer, melanoma, and colon cancer surgeries will require that surgeons provide synoptic documentation of essential oncologic elements within operative reports. Prior to designing and implementing an electronic tool to support synoptic reporting, we evaluated current documentation practices at our institution to understand baseline concordance with these standards. METHODS Applicable procedures performed between 1 January 2018 and 31 December 2018 were included. Two independent reviewers evaluated sequential operative notes, up to a total of 100 notes, for documentation of required elements. Complete concordance (CC) was defined as explicit documentation of all required CoC elements. Mean percentage CC and surgeon-specific CC were calculated for each procedure. Interrater reliability was assessed via Cohen's kappa statistic. RESULTS For sentinel lymph node biopsy, mean CC was 66% (n = 100), with surgeon-specific CC ranging from 6 to 100%, and for axillary dissection, mean CC was 12% (n = 89) and surgeon-specific CC ranged from 0 to 47%. The single surgeon performing melanoma wide local excision had a mean CC of 98% (n = 100). For colon resections, mean CC was 69% (n = 96) and surgeon-specific CC ranged from 39 to 94%. Kappa scores were 0.77, 0.78, -0.15, and 0.78, respectively. CONCLUSIONS We identified heterogeneity in current documentation practices. In our cohort, rates of baseline concordance varied across surgeons and procedures. Currently, documentation elements are interspersed within the operative report, posing challenges to chart abstraction with resulting imperfect interrater reliability. This presents an exciting opportunity to innovate and improve compliance by introducing an electronic synoptic documentation tool.
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Affiliation(s)
| | - Kristin E Goodsell
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jae P Ermer
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Giorgos C Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John T Miura
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicole M Saur
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Najjia N Mahmoud
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ari Brooks
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julia C Tchou
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter E Gabriel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Katz MHG, Francescatti AB, Hunt KK. Technical Standards for Cancer Surgery: Commission on Cancer Standards 5.3–5.8. Ann Surg Oncol 2022; 29:6549-6558. [DOI: 10.1245/s10434-022-11375-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/16/2022] [Indexed: 12/30/2022]
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Däster S, Shin JS, Loizides S, Steffens D, Koh CE, Solomon MJ. Pathology reporting of pelvic exenteration specimens for locally recurrent rectal cancer. Eur J Surg Oncol 2021; 47:2100-2107. [PMID: 33895021 DOI: 10.1016/j.ejso.2021.03.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Reporting of pelvic exenteration specimens for locally recurrent rectal cancer (LRRC) can be challenging for structured pathological analysis and currently, there is a lack of specific guidelines. The aim of this study was to assess the quality of pathology reporting in a cohort of patients who underwent pelvic exenteration for LRRC in a high-volume tertiary unit. MATERIALS AND METHODS In a retrospective analysis of histopathology reports of consecutive patients who underwent pelvic exenteration for LRRC from 1996 to 2018, the quality of pathology reporting was assessed using the Structure Reporting Protocol for Colorectal Cancer. The primary endpoint was the completeness of pathology reporting, secondary endpoints were the association between the reporting style (narrative versus synoptic), reporting period (the first half versus the second half), as well as the activity of the pathologists with the completeness of pathology reporting. RESULTS 221 patients who underwent pelvic exenteration for LRRC were included into the study. There was a high variability in completeness of pathology reporting within the cohort, ranging from 9.5% to 100%. Notably, microscopic clearance was reported in only 92.4% of the reports. Overall, a significantly higher rate of completeness was observed in synoptic reports when compared to narrative reports and in more recent compared to earlier reports. There was no significant association between the activity of pathologists and the completeness of reporting. CONCLUSIONS This study shows a significant variability in the quality of reporting in pelvic exenteration for LRRC. The use of synoptic reporting clearly resulted in more complete reports.
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Affiliation(s)
- Silvio Däster
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Joo-Shik Shin
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Sofronis Loizides
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Qu Z, Zhao K, Jin JG, Qu E, Lai Z. A Novel Method Enables General Pathologists to Create Web Dynamic Forms for Synoptic Tumor Reporting. Arch Pathol Lab Med 2020; 145:864-870. [PMID: 33112959 DOI: 10.5858/arpa.2020-0030-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Tumor reporting constitutes a significant daily task of pathologists. An efficient tumor-reporting methodology is thus vitally important. The Web dynamic form (WbDF) method offers a multitude of advantages over the prevailing transcription-mediated reporting method based on static-text checklists. However, its adaptation has been severely hampered for 2 decades by its costly needs to maintain a complex back-end system and to change the system for frequent updates of reporting content. OBJECTIVE.— To overcome these 2 obstacles with a serverless Web platform that enables users to create, customize, use, and download WbDFs as synoptic templates for structured tumor reporting. DESIGN.— Deploy ReactJS as a Web platform. Create form components in JavaScript Object Notation files. Use JavaScript Object Notation files to make WbDFs on the Web platform. Use the WbDFs to generate final pathology reports. RESULTS.— Ordinary users (pathologists) can create/customize reporting templates as WbDFs on the Web platform. The WbDF can be used to make a pathology report and stored/shared like ordinary document files. There is no back-end system to change, nor a requirement for computer programming skills. CONCLUSIONS.— This strategy eliminates the need for a complex back-end system and the associated cost when updating tumor-reporting standards, making it possible to adopt the WbDF method without the technological drawbacks associated with content updates. It also opens a new field of how the tumor-reporting system should be organized, updated, and implemented.
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Affiliation(s)
- Zhenhong Qu
- From the Department of Pathology, Beaumont Hospital-Royal Oak, Royal Oak, Michigan (Z. Qu, Lai).,NuoNuo Medical Informatics, LLC, Houston, Texas (Z. Qu, E. Qu)
| | - Keran Zhao
- The Department of Information and Decision Sciences, University of Illinois at Chicago (Zhao)
| | - Jason Guo Jin
- The Department of Computer Sciences, University of Michigan, Ann Arbor (Jin)
| | - Elaine Qu
- NuoNuo Medical Informatics, LLC, Houston, Texas (Z. Qu, E. Qu)
| | - Zongshan Lai
- From the Department of Pathology, Beaumont Hospital-Royal Oak, Royal Oak, Michigan (Z. Qu, Lai)
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Assessing the Quality of Rectal Cancer Pathology Reports in National Surgical Adjuvant Breast and Bowel Project Protocol R-04/NRG Oncology. Dis Colon Rectum 2020; 63:1063-1070. [PMID: 32692071 PMCID: PMC7787113 DOI: 10.1097/dcr.0000000000001578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Accurate and comprehensive surgical pathology reports are integral to the quality of cancer care. Despite guidelines from the College of American Pathologists, variations in reporting quality continue to exist. OBJECTIVE The aim of this study was to evaluate the quality of rectal cancer pathology reports and to identify areas of deficiency and potential sources of reporting variations. DESIGN This is a retrospective analysis of prospectively obtained pathology reports. SETTING This study is based at the hospitals participating in the National Surgical Adjuvant Breast and Bowel Project Protocol R-04 study. PATIENTS Patients with rectal cancer undergoing surgical resection between July 2004 and August 2010 were included. MAIN OUTCOME MEASURES The primary outcomes measured were the adherence to the College of American Pathologists guidelines and the impact of synoptic reporting, academic status, rural/urban setting, and hospital bed size on reporting quality. RESULTS We identified 1004 surgical pathology reports for rectal cancer surgery from 383 hospitals and 755 pathologists. The overall adherence rate to the College of American Pathologists guidelines was 73.3%. Notable reporting deficiencies were found in several key pathology characteristics, including tumor histologic grade (reporting rate 77.8%), radial margin (84.6%), distance from the closest margin (47.9%), treatment effect (47.1%), and lymphovascular (73.1%)/perineural invasions (35.4%). Synoptic reporting use and urban hospital settings were associated with better adherence rates, whereas academic status and hospital bed size had no impact. Reporting variations existed not only between institutions, but also within individual hospitals and pathologists. There was a trend for improved adherence over time (2005 = 65.7% vs 2010 = 82.3%, p < 0.001), which coincided with the increased adoption of synoptic reporting by pathologists (2005 vs 2010, 9.4% vs 25.3%, p < 0.001). LIMITATIONS Data were obtained from a restricted setting (ie, hospitals participating in a randomized clinical trial). CONCLUSIONS Wide variations in the quality of pathology reporting are observed for rectal cancer. The National Accreditation Program for Rectal Cancer mandates that programs meet strict quality standards for surgical pathology reporting. Further improvement is needed in this key aspect of oncology care for patients with rectal cancer. See Video Abstract at http://links.lww.com/DCR/B238.ClinicalTrials.gov registration: NCT00058 EVALUACIÓN DE LA CALIDAD DE LOS INFORMES DE PATOLOGÍA QUIRÚRGICA EN CASOS DE CÁNCER DE RECTO DEL NSABP R-04/ ONCOLOGÍA DEL NRG: Un informe de patología quirúrgica preciso y completo es fundamental en la calidad de atención de pacientes con cáncer. A pesar de las normas establecidas por el Colegio Americano de Patología, la variabilidad en la calidad de los informes es evidente.Evaluar la calidad de los informes de patología en casos de cáncer de recto para así identificar las áreas con deficiencias y las posibles fuentes variables en los mencionados informes.Análisis retrospectivo de informes de patología quirúrgica obtenidos prospectivamente.Hospitales que participan del Protocolo del Estudio Nacional R-04 como Adyuvantes Quirúrgicos de Mama e Intestino.Todos aquellos pacientes con cáncer de recto sometidos a resección quirúrgica entre Julio 2004 y Agosto 2010.Cumplimiento de las normas del Colegio Americano de Patología, del impacto de los informes sinópticos, del estado académico, del entorno rural / urbano y el número de camas hospitalarias en en la calidad de los informes.Identificamos 1,004 informes de patología quirúrgica en casos de cirugía en cáncer de recto en 383 hospitales y 755 patólogos. La tasa general de adherencia a las directivas del Colegio Americano de Patología fue del 73.3%. Se encontraron deficiencias notables en los informes en varias características patológicas clave incluidos, el grado histológico del tumor (tasa de informe 77.8%), margenes radiales (84.6%), distancia del margen más cercano (47.9%), efecto del tratamiento (47.1%) invasión linfovascular (73.1 %) / invasion perineural (35.4%). El uso de informes sinópticos y los entornos hospitalarios urbanos se asociaron con mejores tasas de adherencia, mientras que el estado académico y el número de camas hospitalarias no tuvieron ningún impacto. Hubo variaciones en los informes no solo entre instituciones, sino también dentro de hospitales y patólogos individuales. Hubo una tendencia a una mejor adherencia a lo largo del tiempo (2005 = 65.7% v 2010 = 82.3%, p < 0.001), que coincidió con la mayor adopción de informes sinópticos por parte de los patólogos (2005 v 2010, 9.4% v 25.3%, p < 0.001)Datos obtenidos de un entorno restringido (es decir, hospitales que participan en un ensayo clínico aleatorizado).Se observaron grandes variaciones en la calidad de los informes de patología quirúrgica en casos de cáncer de recto. El Programa Nacional de Acreditación para Cáncer de Recto exige que los programas cumplan con estrictos estándares de calidad para los informes de patología quirúrgica. Se necesita una mejoría adicional en este aspecto clave de la atención oncológica para pacientes con cáncer de recto. Video Resumen en http://links.lww.com/DCR/B238.Registro de Clinical Trials.gov: NCT00058.
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Convergence of Digital Pathology and Artificial Intelligence Tools in Anatomic Pathology Practice: Current Landscape and Future Directions. Adv Anat Pathol 2020; 27:221-226. [PMID: 32541593 DOI: 10.1097/pap.0000000000000271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Hewer E. The Oncologist's Guide to Synoptic Reporting: A Primer. Oncology 2019; 98:396-402. [PMID: 31177262 DOI: 10.1159/000500884] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022]
Abstract
Synoptic reporting in tumour pathology is defined by (1) completeness in terms of data elements as well as (2) a specific, laboratory value-like format. Adoption of synoptic reporting leads to more complete reporting of essential parameters, improved standardisation of diagnostic criteria and terminology, as well as easier retrieval of information. It is therefore associated with a high degree of satisfaction among end users including surgeons and oncologists and contributes to improvement of clinical care. Furthermore, synoptic reporting is an important step towards higher levels of data capture, which facilitate data exchange and analysis for quality assurance, cancer epidemiology and clinical and basic research. Increased interest in and adoption of synoptic reporting on a global level is stimulated by the International Collaboration on Cancer Reporting (ICCR) which publishes freely available, evidence-based datasets for reporting an increasing number of different cancer types. These developments pave the path for increased future application of synoptic reporting across the entire field of oncologic medicine, where it will likely deploy similar benefits to those in pathology. Given that synoptic reporting can be considered the most precise means available for reporting of medical findings, it may be predicted to be critical for the promise of precision medicine to become real.
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Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland,
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8
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Brown PJ, Rossington H, Taylor J, Lambregts DMJ, Morris EJA, West NP, Quirke P, Tolan D. Radiologist and multidisciplinary team clinician opinions on the quality of MRI rectal cancer staging reports: how are we doing? Clin Radiol 2019; 74:637-642. [PMID: 31084973 DOI: 10.1016/j.crad.2019.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the current opinion of magnetic resonance imaging (MRI) reports amongst specialist clinicians involved in colorectal cancer multidisciplinary teams (CRC MDTs). MATERIALS AND METHODS Active participants at 16 UK CRC MDTs across a population of 5.7 million were invited to complete a questionnaire, this included 22 closed and three open questions. Closed questions used ordinal (Likert) scales to judge the subjective inclusion of tumour descriptors and impressions on the clarity and consistency of the MRI report. Open (free-text) questions allowed overall feedback and suggestions. RESULTS A total of 69 participants completed the survey (21 radiologists and 48 other CRC MDT clinicians). Both groups highlighted that reports commonly omit the status of the circumferential resection margin (CRM; 83% versus 81% inclusion, other clinicians and radiologists, respectively, p>0.05), presence or absence of extra-mural venous invasion (EMVI; 67% versus 57% inclusion, p>0.05), and lymph node status (90% inclusion in both groups). Intra-radiologist agreement across MRI examinations is reported as 75% by other clinicians. Free-text comments included suggestions for template-style reports. CONCLUSION Both groups recognise a proportion of MRI reports are suboptimal with key tumour descriptors omitted. There are also concerns around the presentation style of MRI reports and inter- and intra-radiologist report variability. The widespread implementation of standardised report templates may improve completeness and clarity of MRI reports for rectal cancer and thus clinical management and outcomes in rectal cancer.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - H Rossington
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - J Taylor
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D M J Lambregts
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, Netherlands
| | - E J A Morris
- Epidemiology and Biostatistics, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - N P West
- Pathology, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - P Quirke
- Pathology, Section of Pathology and Data Analytics, Medical Research at St. James's, University of Leeds, St James's Institute of Oncology, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D Tolan
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
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Standardised reports with a template format are superior to free text reports: the case for rectal cancer reporting in clinical practice. Eur Radiol 2019; 29:5121-5128. [PMID: 30796574 PMCID: PMC6682848 DOI: 10.1007/s00330-019-06028-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Rectal cancer staging with magnetic resonance imaging (MRI) allows accurate assessment and preoperative staging of rectal cancers. Therefore, complete MRI reports are vital to treatment planning. Significant variability may exist in their content and completeness. Template-style reporting can improve reporting standards, but its use is not widespread. Given the implications for treatment, we have evaluated current clinical practice amongst specialist gastrointestinal (GI) radiologists to measure the quality of rectal cancer staging MRI reports. MATERIALS AND METHODS Sixteen United Kingdom (UK) colorectal cancer multi-disciplinary teams (CRC-MDTs) serving a population over 5 million were invited to submit up to 10 consecutive rectal cancer primary staging MRI reports from January 2016 for each radiologist participating in the CRC-MDT. Reports were compared to a reference standard based on recognised staging and prognostic factors influencing case management RESULTS: Four hundred ten primary staging reports were submitted from 41 of 42 (97.6%) eligible radiologists. Three hundred sixty reports met the inclusion criteria, of these, 81 (22.5%) used a template. Template report usage significantly increased recording of key data points versus non-template reports for extra-mural venous invasion (EMVI) status (98.8% v 51.6%, p < 0.01) and circumferential resection margin (CRM) status (96.3% v 65.9%, p < 0.01). Local tumour stage (97.5% v 93.5%, NS) and nodal status (98.8% v 96.1%, NS) were reported and with similar frequency. CONCLUSION Rectal cancer primary staging reports do not meet published standards. Template-style reports have significant increases in the inclusion of key tumour descriptors. This study provides further support for their use to improve reporting standards and outcomes in rectal cancer. KEY POINTS • MRI primary staging of rectal cancer requires detailed tumour descriptions as these alter the neoadjuvant and surgical treatments. • Currently, rectal cancer MRI reports in clinical practice do not provide sufficient detail on these tumour descriptors. • The use of template-style reports for primary staging of rectal cancer significantly improves report quality compared to free-text reports.
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Abstract
R1 resections in rectal cancer particularly affect the circumferential resection margin (CRM) and lead to increased local recurrence rates, more distant metastases and a poorer prognosis. The proximity of the tumor to the CRM is already sufficient to increases these risks; therefore, according to the guidelines, it is now necessary to distinguish between R0 wide (≥1 mm distance), R0 close (<1 mm) and R1. The surgical technique is decisive for avoiding R1 situations. The preparation follows the boundary layers and envelope fascia in a standardized radical way and if necessary deviates away from these structures and the tumor under en bloc resection of neighboring structures. Neoadjuvant therapy also contributes to the reduction of R1 situations but cannot compensate for inadequate surgical procedures.
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Keane C, Lin AY, Kramer N, Bissett I. Can pathological reports of rectal cancer provide national quality indicators? ANZ J Surg 2018; 88:E639-E643. [DOI: 10.1111/ans.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Celia Keane
- Department of Surgery; The University of Auckland; Auckland New Zealand
| | - Anthony Y. Lin
- Department of Surgery; The University of Auckland; Auckland New Zealand
- Department of Surgery; Auckland City Hospital; Auckland New Zealand
| | - Nicole Kramer
- Department of Pathology; Auckland City Hospital; Auckland New Zealand
| | - Ian Bissett
- Department of Surgery; The University of Auckland; Auckland New Zealand
- Department of Surgery; Auckland City Hospital; Auckland New Zealand
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12
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McCudden CR, Booth RA, Lin DC, McCurdy A, Rupani N, Kew A. Synoptic reporting for protein electrophoresis and immunofixation. Clin Biochem 2018; 51:21-28. [DOI: 10.1016/j.clinbiochem.2017.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/24/2023]
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Awaysheh A, Wilcke J, Elvinger F, Rees L, Fan W, Zimmerman K. A review of medical terminology standards and structured reporting. J Vet Diagn Invest 2017; 30:17-25. [PMID: 29034813 DOI: 10.1177/1040638717738276] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Much effort has been invested in standardizing medical terminology for representation of medical knowledge, storage in electronic medical records, retrieval, reuse for evidence-based decision making, and for efficient messaging between users. We only focus on those efforts related to the representation of clinical medical knowledge required for capturing diagnoses and findings from a wide range of general to specialty clinical perspectives (e.g., internists to pathologists). Standardized medical terminology and the usage of structured reporting have been shown to improve the usage of medical information in secondary activities, such as research, public health, and case studies. The impact of standardization and structured reporting is not limited to secondary activities; standardization has been shown to have a direct impact on patient healthcare.
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Affiliation(s)
- Abdullah Awaysheh
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine (Awaysheh, Wilcke, Zimmerman), Virginia Tech, Blacksburg, VA.,Department of Business Information Technology, Pamplin College of Business (Rees, Fan), Virginia Tech, Blacksburg, VA.,Animal Health Diagnostic Center, Cornell University, Ithaca, NY (Elvinger)
| | - Jeffrey Wilcke
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine (Awaysheh, Wilcke, Zimmerman), Virginia Tech, Blacksburg, VA.,Department of Business Information Technology, Pamplin College of Business (Rees, Fan), Virginia Tech, Blacksburg, VA.,Animal Health Diagnostic Center, Cornell University, Ithaca, NY (Elvinger)
| | - François Elvinger
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine (Awaysheh, Wilcke, Zimmerman), Virginia Tech, Blacksburg, VA.,Department of Business Information Technology, Pamplin College of Business (Rees, Fan), Virginia Tech, Blacksburg, VA.,Animal Health Diagnostic Center, Cornell University, Ithaca, NY (Elvinger)
| | - Loren Rees
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine (Awaysheh, Wilcke, Zimmerman), Virginia Tech, Blacksburg, VA.,Department of Business Information Technology, Pamplin College of Business (Rees, Fan), Virginia Tech, Blacksburg, VA.,Animal Health Diagnostic Center, Cornell University, Ithaca, NY (Elvinger)
| | - Weiguo Fan
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine (Awaysheh, Wilcke, Zimmerman), Virginia Tech, Blacksburg, VA.,Department of Business Information Technology, Pamplin College of Business (Rees, Fan), Virginia Tech, Blacksburg, VA.,Animal Health Diagnostic Center, Cornell University, Ithaca, NY (Elvinger)
| | - Kurt Zimmerman
- Department of Biomedical Sciences and Pathobiology, VA-MD College of Veterinary Medicine (Awaysheh, Wilcke, Zimmerman), Virginia Tech, Blacksburg, VA.,Department of Business Information Technology, Pamplin College of Business (Rees, Fan), Virginia Tech, Blacksburg, VA.,Animal Health Diagnostic Center, Cornell University, Ithaca, NY (Elvinger)
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Sergi C, Shen F, Bouma G. Intraepithelial lymphocytes, scores, mimickers and challenges in diagnosing gluten-sensitive enteropathy (celiac disease). World J Gastroenterol 2017; 23:573-589. [PMID: 28216964 PMCID: PMC5292331 DOI: 10.3748/wjg.v23.i4.573] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/27/2016] [Accepted: 12/16/2016] [Indexed: 02/06/2023] Open
Abstract
The upper digestive tract is routinely scoped for several causes of malabsorption, and the number of duodenal biopsy specimens has increased notably in the last 10 years. Gluten-sensitive enteropathy (GSE) is an autoimmune disease, which shows an increasing prevalence worldwide and requires a joint clinico-pathological approach. The classical histopathology of GSE with partial or total villous blunting is well recognized, but the classification of GSE is not straightforward. Moreover, several mimickers of GSE with intraepithelial lymphocytosis have been identified in the last 20 years, with drug interactions and medical comorbidities adding to the conundrum. In this review, we report on the normal duodenal mucosa, the clinical presentation and laboratory diagnosis of GSE, the duodenal intraepithelial lymphocytes and immunophenotype of GSE-associated lymphocytes, the GSE mimickers, the differences "across oceans" among guidelines in diagnosing GSE, and the use of a synoptic report for reporting duodenal biopsies in both children and adults in the 21st century.
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