Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer: a framework for developing an objective pathological diagnostic system using the Delphi method, from the Pathology Working Group of the Japanese Society for Cancer of the Colon and Rectum
- Motohiro Kojima1,
- Hideyuki Shimazaki2,
- Keiichi Iwaya2,
- Masayoshi Kage3,
- Jun Akiba4,
- Yasuo Ohkura5,
- Shinichiro Horiguchi6,
- Kohei Shomori7,
- Ryoji Kushima8,
- Yoichi Ajioka9,
- Shogo Nomura10,
- Atsushi Ochiai1
- 1Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa,Chiba, Japan
- 2Department of Pathology, National Defence Medical College, Saitama, Japan
- 3Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
- 4Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- 5Department of Pathology, Kyorin University Graduate School of Medicine, Tokyo, Japan
- 6Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
- 7Division of Organ Pathology, Department Microbiology and Pathology, Faculty of Medicine Tottori University, Tottori, Japan
- 8Pathology Division, National Cancer Center Hospital, Tokyo, Japan
- 9Department of Pathology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
- 10Clinical Trial Section, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan
- Correspondence to Dr Atsushi Ochiai, Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan;
- Received 20 July 2012
- Revised 25 December 2012
- Accepted 8 January 2013
- Published Online First 16 April 2013
Aims The goal of this study is to create an objective pathological diagnostic system for blood and lymphatic vessel invasion (BLI).
Methods 1450 surgically resected colorectal cancer specimens from eight hospitals were reviewed. Our first step was to compare the current practice of pathology assessment among eight hospitals. Then, H&E stained slides with or without histochemical/immunohistochemical staining were assessed by eight pathologists and concordance of BLI diagnosis was checked. In addition, histological findings associated with BLI having good concordance were reviewed. Based on these results, framework for developing diagnostic criterion was developed, using the Delphi method. The new criterion was evaluated using 40 colorectal cancer specimens.
Results Frequency of BLI diagnoses, number of blocks obtained and stained for assessment of BLI varied among eight hospitals. Concordance was low for BLI diagnosis and was not any better when histochemical/immunohistochemical staining was provided. All histological findings associated with BLI from H&E staining were poor in agreement. However, observation of elastica-stained internal elastic membrane covering more than half of the circumference surrounding the tumour cluster as well as the presence of D2-40-stained endothelial cells covering more than half of the circumference surrounding the tumour cluster showed high concordance. Based on this observation, we developed a framework for pathological diagnostic criterion, using the Delphi method. This criterion was found to be useful in improving concordance of BLI diagnosis.
Conclusions A framework for pathological diagnostic criterion was developed by reviewing concordance and using the Delphi method. The criterion developed may serve as the basis for creating a standardised procedure for pathological diagnosis.
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