Malignant Colorectal Polyp Pathology: Are We Getting Sufficient Information to Make Decisions?

BACKGROUND: The College of American Pathologists has published guidelines for malignant colorectal polyp pathology reports that list histopathological features that are "core elements" and "optional." Lack of element reporting may result in inaccurate tumor risk stratification.This study aimed to perform a population-based assessment of pathology reporting for T1 colorectal cancers and determine the completeness of reporting for core and optional histopathological elements.This is a retrospective cohort study.This study reviews the pathology reports of endoscopically resected malignant colorectal polyps in Alberta, Canada between 2014 and 2016.Individuals aged 18 years or older with T1 colorectal polyps were selected.Histopathological elements were dichotomized into core and optional. Malignant polyps were classified as high risk or low risk for lymph node metastases and local intraluminal recurrence. Addendum reports were compared with first reports.After applying exclusion criteria, 431 polyps were analyzed. The mean age of patients was 65.5 years; 59.4% were male. Histological grade, deep margin, and lymphovascular invasion were reported in 82.4%, 86.8% and 75.6%; all 3 were reported in only 66.4%. Tumor budding (not in the 2016 guidelines) was reported in 14.4%. One hundred ninety polyps (44.1%) were high risk. Thirty-seven polyps (8.3%) had an addendum report. Following the addendum, 1 polyp was downgraded to low risk, and 9 polyps were upgraded to high risk.The main limitation of the study is its retrospective nature. The decision making surrounding treatment for T1 cancers is complex, and factors other than histopathological tumor features may have been part of treatment decisions.There is a high rate of incomplete reporting of core and optional elements for malignant colorectal polyp pathology reports in Alberta. Several variables used by colorectal surgeons for decision making, such as tumor budding and depth of submucosal invasion, are not considered core elements and are infrequently reported. A pathology review by a second pathologist often results in a change in risk stratification. See Video Abstract at http://links.lww.com/DCR/B98. PATOLOGIA DEL POLIPO COLORRECTAL MALIGNO: inverted question markESTAMOS OBTENIENDO INFORMACION SUFICIENTE PARA TOMAR DECISIONES?: El Colegio de Patologos Americanos publico pautas para informes de patologia de polipos colorrectales malignos que enumeran caracteristicas histopatologicas como "elementos centrales" y "opcionales". La falta de informacion elemental puede resultar en una estratificacion de riesgo tumoral imprecisa.Valoracion basada en una poblacion de los informes de patologia para los canceres colorrectales T1 y determinar la precision de los informes en cuanto los elementos histopatologicos centrales y opcionales.Estudio de cohorte retrospectivo.Este estudio revisa los informes de patologia de polipos colorrectales malignos resecados endoscopicamente en Alberta, Canada, entre 2014 y 2016.personas mayores de 18 anos con polipos colorrectales T1.Los elementos histopatologicos se dicotomizaron entre elementales y opcionales. Polipos malignos se clasificaron como de alto riesgo o bajo riesgo de metastasis en los ganglios linfaticos y recurrencia intraluminal local. Los informes enmendados se compararon con los informes originales.Despues de aplicar los criterios de exclusion, se analizaron 431 polipos. La edad media fue 65.5 anos, con 59.4% masculinos. El grado histologico, el margen profundo y la invasion linfovascular se informaron confirmaron en 82.4%, 86.8% y 75.6% respectivamente; las tres caracteristicas se demostraron en solo 66.4%. Un patron tumoral en ciernes se reporto en 14.4-una caracteristica que no se usaba en las guias de 2016. Ciento noventa polipos (44.1%) eran de alto riesgo. Treinta y siete polipos (8.3%) requirieron de un informe enmendado. Aplicacion de los nuevos criterios resulto en que 1 polipo se redujo a bajo riesgo y 9 polipos se actualizaron como a alto riesgo.La principal limitacion del estudio es el diseno retrospectivo. La toma de decisiones en torno al tratamiento de los canceres T1 es compleja y otros factores ademas de las caracteristicas histopatologicas del tumor pueden haber sido parte de las decisiones terapeuticas.Hay una alta tasa de informes incompletos de elementos centrales y opcionales para informes de patologia de polipos colorrectales malignos en Alberta. Algunas variables utilizadas por los cirujanos colorrectales para la toma de decisiones, como el patron tumoral en ciernes y la profundidad de la invasion submucosa, no se consideran elementos centrales y se informan con poca frecuencia. Una revision de patologia realizada por un segundo patologo a menudo resulta en un cambio en la estratificacion del riesgo. Consulte Video Resumen en http://links.lww.com/DCR/B98. (Traduccion-Dr. Adrian E. Ortega).