Colorectal cancer pathology reporting: a regional audit


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Rebecca Birch1,2, Eva Morris1,2, Nicholas West1, Paul Finan1, Phil Quirke1
1University of Leeds, Leeds, UK, 2Northern and Yorkshire Cancer Registry and Information Service, Leeds, UK

Background

The Royal College of Pathologists recommends the completion of a histopathological minimum dataset to report resected colorectal cancers. This study aimed to audit the quality and completeness of these reports.

Method

All minimum datasets for resected colorectal tumours submitted to the Northern & Yorkshire Cancer Registry & Information Service (NYCRIS) between 1993 and 2010 were examined. Trends in the data were analysed by year, NHS Trust and overall.

Results

28,282 major resections for colorectal cancer occurred in the 10 submitting NHS Trusts over the study period and minimum datasets were available for 20,488 (72.4%) of the resected specimens.

Circumferential margin status (CRM) was recorded in 82.7% of rectal cancer cases. Reporting of longitudinal margin status was variable, with the status of the proximal/distal margin being recorded in 91.1% of cases whilst the status of the doughnuts was recorded in just over half the population (51.8%). Local invasion and number of nodes examined contained the smallest amount of missing data (complete in 98.7% and 98.3% of cases).

Reporting varied by up to 60% between trusts. Completeness of differentiation by predominant area ranged from 26.6% to 95.3%, a similar pattern was seen in the recording of histological type and CRM. The number of lymph nodes identified improved with time, with the median yield increasing from 5.5 nodes in 1994 to 18 in 2010. An improvement was also seen in extramural vascular invasion with the completeness of this field increasing from 18.0% to 95.1%.

Full staging information (I, II, III, IV) was recorded in 91.5% of cases and partial staging was available in 97.5%. Overall 13.9% were stage I, 36.5% stage II, 40.8% stage III, 0.3% stage IV and 8.5% were unrecorded.

Conclusion

This study demonstrates an improvement in pathology reporting, but, several important prognostic factors remain under reported.