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An international survey-based study on colorectal cancer pathology reporting—guidelines versus local practice

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Abstract

Different guidelines for colorectal cancer (CRC) pathology reporting have been published. We aimed to identify differences between publicly available CRC reporting guidelines and to survey pathologists from different countries to establish the degree of guideline implementation in local routine practice. We compared all core and non-core items of CRC reporting guidelines to identify discrepancies. We then created a survey, which was sent out to 782 pathologists practicing in 30 different countries. It included questions on the demographics of the reporting pathologist as well as resection specimen handling and microscopic evaluation, grading, staging, and additional techniques, such as immunohistochemistry or molecular pathology. First, core and non-core items of five national CRC reporting guidelines were compared and 12 items were found to differ. Different items are considered core or non-core by different guidelines and more than one TNM staging edition was applied across guidelines. The survey was completed by 143 pathologists from 30 countries. We identified differences between local practice and guidelines with potential clinical impact, e.g., tumor budding was never reported by 28.7% of responders, although it has prognostic value for survival in stage II CRC. This is the first international study comparing CRC pathology reporting guidelines with real-world local practices. There are differences in CRC pathology reporting guidelines and in guideline implementation into local practice, both with potential impact on patient care. Harmonization of datasets, use of templates, and audits of local pathology practice are needed to ensure best possible quality of CRC pathology reporting.

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Acknowledgements

The responders: Federica Grillo, Frank Carey, Snjezana Frkovic-Grazio, Camille Boulagnon-Rombi, Maurice Loughrey, Francois Paraf, Katerina Kamaradova, Peggy Dartigues, Bettina Rees, Timo Gaiser, Clare Fuller, Marie-Christine Saint-Paul, Rui Oliveira, Stefania Landolfi, Emyr Wyn Benbow, Billaud Elsa, Ricardo Fonseca, Anne Jouret-Mourin, Kevin West, Remi Picot, Eugene Mutijima, Cinzia Giacometti, Rob Goldin, Michael Taris, Yolanda Rodriguez-Gil, Ruth Düttmann, Nigel Scott, Marie-Danièle Diebold, Alejandro García-Varona, Dina Tiniakos, Luca Albarello, Flora Poizat, Marnix Jansen, Lígia Castro, Angus McGregor, Gorana Aralica, Branko Dmitrovic, Nevine El Deeb, Fulop Emoke, Caroline Gabignon, Paul Barrett, Norman Carr, Bruno Sinn, Sophie Michalak, Simona Gurzu, Giovanni De Petris, Danny Goudkade, Julia Rees, Isabelle Focke-Snieders, Michael Vieth, Adriana Martinez, Anne Couvelard, Antonella Savio, Desislava Tashkova, Caitlin Beggan, María-Luisa Sánchez-Bernal, Alessandro D’Amuri, Eugeniu Cazacu, Veena Shinde, Valeria Barresi, Kamran Ghaffarzadehgan, Jaroslaw Wejman,Ann Fleming, Maria-Jose Paules, Parag Dabir, Roberto Fiocca, Meleri Morgan, Olivia Cambero, Ioannis Provatas, Antonio Ieni, Ray McMahon, Catherine Julie, Roberto Salgado, Viorica Crisan, Izhar Bagwan, Gonca Ozgun, Bence Kővári, Carine De Prez, Adam Christian, Ana Cunha, Hajnalka Gyorffy, Andreea-Cristina Iogrescu, Marek Grega, Houria Belkralladi, Maria Brito, Leroux Agnès, Renata Chmelova, Florence Renaud, Felix Lasitschka, Nina Zidar, Karthik Kalyanasundaram, Armelle Bardier, Fiebo ten Kate, Jera Jeruc, Catherine lo Polito, Marie-Louise van Velthuysen, Nick West, Mukul Vij, Joost van Gorp, Vincenzo Villanacci, Frederic Bibeau, Ari Ristimäki, Nicholas Mapstone, Yasmine Lahoubi, Issam Abd-Alsmad, Xavier Sanjuan, Miriam Cuatrecasas, Carolina Ibarrola, Cecilia Egoavil Rojas, Eva Sticova, Fred Bosman, Manuela Vivario, Julian Ananiev, Maysa Al-Hussaini, Nathalie Guedj, Ana Dias, Christine Sempoux, Nicole van Grieken, Valentini Tzioufa-Asimakopoulou, Maria Gomez-Galdon, Maria Diodoro, Namor Williams, Kristina Tõnismäe, Calypso Barbatis,Fatima Carneiro, Elvira Gonzalez-Obeso, Gaetan MacGrogan, Isinsu Kuzu, Jens Neumann, Ratnadeep Ganguly, Daniel Val-Garijo, and those who did not submit their names. Technical support: Leonardo Perez-Aranda Alonso, Aida Molero-Bermejo, Vinciane Vincx, Katherine Hartmann, Jennifer Crespo, Francoise Meunier, Jouri Van Den Bergh, Jonathan O’Sullivan, Denis Lacombe, and Raed Al Dieri.

Contributions

Maria Urbanowicz, Heike I Grabsch, and Jean-François Fléjou conceived and designed the study and wrote, edited, and reviewed the manuscript. All authors researched and analyzed data and wrote, edited, and reviewed the manuscript and gave final approval for publication. All authors take full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.

Funding

No funding was destined for this publication. Maria Urbanowicz’s work as Fellow at EORTC Headquarters was supported by a grant from the ESP and the EORTC Cancer Research Fund.

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Author notes

  1. Maria Urbanowicz and Heike I. Grabsch contributed equally to this work.

Authors and Affiliations

  1. European Organisation for Research and Treatment of Cancer (EORTC), Avenue Emmanuel Mounier 83/11, 1200, Brussels, Belgium

    Maria Urbanowicz, Yan Liu & Carmela Caballero

  2. European Society of Pathology, Rue Bara 6, 1070, Brussels, Belgium

    Maria Urbanowicz & Jean-François Fléjou

  3. Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands

    Heike I. Grabsch

  4. Pathology, School of Medicine, University of Leeds, Leeds, UK

    Heike I. Grabsch

  5. Medical oncology department, University Hospital of Nîmes, Place du Professeur Robert Debré, 30029, Nîmes, France

    Frederic Fiteni

  6. Biometry Unit, Institut Du Cancer de Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France

    Frederic Fiteni

  7. University of Montpellier, 163 Rue Auguste Broussonnet, 34090, Montpellier, France

    Frederic Fiteni

  8. AP-HP Service d’Anatomie Pathologique, Hôpital Saint-Antoine, Faculté de Médecine Sorbonne Université, 184 rue du faubourg Saint-Antoine, F-75012, Paris, France

    Jean-François Fléjou

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  1. Maria Urbanowicz
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Urbanowicz, M., Grabsch, H.I., Fiteni, F. et al. An international survey-based study on colorectal cancer pathology reporting—guidelines versus local practice. Virchows Arch 473, 697–708 (2018). https://doi.org/10.1007/s00428-018-2457-3

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