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Tytuł pozycji:

Varying practices in tumor regression grading of gastrointestinal carcinomas after neoadjuvant therapy: results of an international survey.

Tytuł :
Varying practices in tumor regression grading of gastrointestinal carcinomas after neoadjuvant therapy: results of an international survey.
Autorzy :
Westerhoff M; Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
Osecky M; Institute of Pathology, University of Bern, Bern, Switzerland.
Langer R; Institute of Pathology, University of Bern, Bern, Switzerland. .
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Źródło :
Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc [Mod Pathol] 2020 Apr; Vol. 33 (4), pp. 676-689. Date of Electronic Publication: 2019 Oct 31.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: <2004- > : New York, NY : Nature Pub. Group
Original Publication: Baltimore, MD : Williams & Wilkins, c1988-
MeSH Terms :
Neoadjuvant Therapy*
Carcinoma/*pathology
Carcinoma/*therapy
Gastrointestinal Neoplasms/*pathology
Gastrointestinal Neoplasms/*therapy
Healthcare Disparities/*trends
Neoplasm Grading/*trends
Pathologists/*trends
Practice Patterns, Physicians'/*trends
Biopsy/trends ; Health Care Surveys ; Humans ; Predictive Value of Tests ; Remission Induction ; Staining and Labeling/trends ; Treatment Outcome
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Entry Date(s) :
Date Created: 20191102 Date Completed: 20210125 Latest Revision: 20210125
Update Code :
20210210
DOI :
10.1038/s41379-019-0393-7
PMID :
31673084
Czasopismo naukowe
Tumor regression grading is routinely performed on neoadjuvantly treated gastrointestinal cancer resections. Challenges in tumor regression grading include grossing standards, multiple grading systems, and difficulty interpreting therapy-induced changes. We surveyed gastrointestinal pathologists around the world for their practices in handling neoadjuvantly treated gastrointestinal cancer specimens and reporting tumor regression using a 23-question online survey. Topics addressed grossing, histologic work-up, tumor regression grading systems, and degree of difficulty identifying and estimating residual cancer within treatment effect. Two-hundred three responses were received, including 173 participants who completed the entire questionnaire. Fifty percent of the participants were from Europe, 29% from North America, 10% from Australia, and 11% from other continents. Ninety-five percent routinely report a tumor regression grade and 92% have standardized grossing and histologic work-up: 27% always completely embed the entire tumor bed, 54% embed the complete tumor site if not a grossly apparent, large mass. Fifty-nine percent use hematoxylin & eosin alone for assessment; the remaining use additional stains. In North America and Australia, the American Joint Committee on Cancer (AJCC)/College of American Pathologists (CAP)/Ryan system is routinely used for gastroesophageal (71%) and rectal carcinomas (77%). In Europe, the Mandard system is common (36%) for gastroesophageal tumors, followed by AJCC/CAP/Ryan (22%), and Becker (10%); for rectal CA, the Dworak system (30%) is followed by AJCC/CAP/Ryan (24%) and Mandard (14%). This regional differences were significant (p < 0.001 each). Fifty-one percent prefer a four-tiered system. Sixty-six percent think that regressive changes in lymph nodes should be part of a regression grade. Sixty-nine percent consider identifying residual tumor straight-forward, but estimating therapy-induced fibrosis difficult (57%). Free comments raised issues of costs for work-up and clinical relevance. In conclusion, this multinational survey provides a comprehensive overview of grossing and histologic work-up with regards to tumor regression grading in gastrointestinal cancers with partly significant regional differences particularly between North America and Europe.

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