The Ueno method for substaging pT1 colorectal adenocarcinoma by depth and width measurement: an interobserver study

Wang, L M; Guy, Richard; Fryer, Eve; Kartsonaki, Christiana; Gill, Paul; Hughes, Caroline; Szűts, Áron; Perera, Rafael; Chetty, Runjan; Mortensen, N. J. McC.

doi:10.1111/codi.12910

Cited by 17 publications

(12 citation statements)

References 35 publications

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“…We have just published an audit [4] and have shown, unfortunately, that experienced gastrointestinal histopathologists are not in unison in reporting prognostic parameters. We have shown in this paper that the recognition of width of invasion is not very good, thus confirming the findings of the Oxford group [5]. Furthermore the agreement on grade and lymphovascular invasion was well below par as was agreement on the depth of invasion when applying Haggitt's and Kikuchi levels.…”

Section: Dear Sirsupporting

confidence: 87%

SPECC and SPECULATION

Haboubi

Salmo

2016

Colorectal Disease

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Section: Dear Sirsupporting

confidence: 87%

SPECC and SPECULATION

Haboubi

Salmo

2016

Colorectal Disease

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Section: Discussionmentioning

confidence: 74%

“…When the muscularis propria is included in the specimen, the pathological classification is more accurate, with risk of lymph-nodes metastases of 0% for Kikuchi sm1, 10% for sm2 and 25% for sm3. 14 Nascimbeni at al reported very similar figures in a large Mayo Clinic study of T1 colorectal cancer after surgical resection. 24 The low recurrence rate after organ preservation confirms previous data showing that recurrences are uncommon, 9 often diminutive, 18 and therefore infrequently requiring surgical resection.…”

Section: Discussionmentioning

confidence: 74%

Management of Significant Polyp and Early Colorectal Cancer Is Optimized by Implementation of a Dedicated Multidisciplinary Team Meeting: Lessons Learned From the United Kingdom National Program

Fabio

Jitsumura

Longstaff

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND:The concept of significant polyps and early colorectal cancer encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. The assessment and management of these lesions is contentious and increasingly important due to the significant risk of over-or undertreatment. OBJECTIVE:Following the recommendations of the Significant Polyps and Early Colorectal Cancer National Program, we implemented a dedicated multidisciplinary team meeting and analyzed the influence on patient outcomes. DESIGN:This was a retrospective study using a prospectively collected database of patients discussed at the dedicated multidisciplinary team meeting. SETTINGS:This study was conducted in a single tertiarycare center.PATIENTS: Consecutive patients with significant polyps and early colorectal cancer were identified either through the Bowel Cancer Screening Program or colonoscopy for symptomatic patients. MAIN OUTCOME MEASURES:Proportions of patients who had organ preservation, and secondary treatment and recurrence rate served as outcome measures. RESULTS:Overall, 135 patients discussed at the dedicated multidisciplinary team meeting were included, with a median age of 71 years. Median size of the lesions was 25 mm, and 39% were in the rectum. Patients were discussed either after the lesion was removed during the initial colonoscopy (n = 38), of whom 16 (42%) had unexpected cancer, or had no initial treatment with subsequent case review (n = 97). Of these 97 patients, 46 underwent endoscopic excision (26% cancer), 20 transanal excision (10% cancer), 23 primary surgical resection (35% cancer), and 8 had no treatment. In 104 (82%) patients, organ preservation was achieved. Secondary surgery was required in 7 of 104 (6.7%) patients after local excision due to radical treatment of high-risk T1 lesions, local recurrence, or patients' decisions. The cumulative hazard estimates for recurrence after a median follow-up of 18.5 months was less than 10% for both benign and malignant lesions. LIMITATIONS:This study was limited by its relatively small sample size and single-center setting. CONCLUSIONS:A dedicated multidisciplinary team meeting improved the management of significant polyps and early colorectal cancer, safely refining organ preservation for patients, with low recurrence rates. See

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“…Tumor differentiation grade was attributed according to the least differentiated tumoral component (24). The depth and width of submucosal invasion were assessed and analyzed using 1 and 4 mm cutoff values, respectively (27)(28)(29).…”

Section: Dataset Constructionmentioning

confidence: 99%

The Importance of Being “That” Colorectal pT1: A Combined Clinico-Pathological Predictive Score to Improve Nodal Risk Stratification

et al. 2022

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The management of endoscopically resected pT1 colorectal cancer (CRC) relies on nodal metastasis risk estimation based on the assessment of specific histopathological features. Avoiding the overtreatment of metastasis-free patients represents a crucial unmet clinical need. By analyzing a consecutive series of 207 pT1 CRCs treated with colectomy and lymphadenectomy, this study aimed to develop a novel clinicopathological score to improve pT1 CRC metastasis prediction. First, we established the clinicopathological profile of metastatic cases: lymphovascular invasion (OR: 23.8; CI: 5.12–110.9) and high-grade tumor budding (OR: 5.21; CI: 1.60–16.8) correlated with an increased risk of nodal metastasis, while age at diagnosis >65 years (OR: 0.26; CI: 0.09–0.71) and high tumor-infiltrating lymphocytes (OR: 0.19; CI: 0.06–0.59) showed a protective effect. Combining these features, we built a five-tier risk score that, applied to our series, identified cases with a higher risk (score ≥ 2) of nodal metastasis (OR: 7.7; CI: 2.4–24.4). Notably, a score of 0 was only assigned to cases with no metastases (13/13 cases) and all the score 4 samples (2/2 cases) showed nodal metastases. In conclusion, we developed an effectively combined score to assess pT1 CRC nodal metastasis risk. We believe that its adoption within a multidisciplinary pT1 unit could improve patients' clinical management and limit surgical overtreatment.

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The Ueno method for substaging pT1 colorectal adenocarcinoma by depth and width measurement: an interobserver study

Abstract: Ueno's method has the advantage of being independent of polyp morphology. Our study shows better concordance for depth measurement and reproducibility in nonfragmented specimens, with poorer agreement when based on width.

Cited by 17 publications

References 35 publications

SPECC and SPECULATION

SPECC and SPECULATION

Management of Significant Polyp and Early Colorectal Cancer Is Optimized by Implementation of a Dedicated Multidisciplinary Team Meeting: Lessons Learned From the United Kingdom National Program

The Importance of Being “That” Colorectal pT1: A Combined Clinico-Pathological Predictive Score to Improve Nodal Risk Stratification

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