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Impact of Referral Center Pathology Review on Diagnosis and Management of Patients With Appendiceal Neoplasms.

Abstract：

CONTEXT.—:Data regarding the clinical impact of subspecialist pathology review of appendiceal neoplasms are limited. OBJECTIVE.—:To determine whether pathology review by gastrointestinal pathologists at a tertiary-care referral center resulted in significant changes in the diagnosis and clinical management of appendiceal neoplastic lesions. DESIGN.—:We conducted a retrospective review of all patients with an initial diagnosis of appendiceal neoplasm referred to a tertiary-care referral center in Ontario, Canada, from 2010-2016. The discordance rate between original and review pathology reports, the nature of discordances, and the impact of any discordance on patient management were recorded. RESULTS.—:A total of 145 patients with appendiceal lesions were identified (low-grade mucinous appendiceal neoplasm [n = 79], invasive mucinous adenocarcinoma [n = 12], "colorectal type" adenocarcinoma [n = 12], goblet cell carcinoid and adenocarcinomas ex goblet cell carcinoid [n = 24], and other lesions/neoplasms [n = 20]). One or more changes in diagnoses were found in 36 of 145 cases (24.8%), with changes within the same category of interpretation (n = 10), stage (n = 7), grade (n = 6), and categoric interpretation (n = 5) being the most common. In 10 of 36 patients (28%), the diagnostic change led to a significant change in management, including recommendation for additional surveillance, systemic chemotherapy, additional surgery, or discontinuation of surveillance. CONCLUSIONS.—:Subspecialist pathology review of appendiceal neoplastic lesions led to a change in diagnosis in 36 of 145 cases (24.8%), of which nearly 30% (10 of 36 cases) led to a change in clinical management. The overall rate of clinically significant discordances was 7% (10 of 145). Our findings suggest that subspecialist pathology review of appendiceal neoplasms referred to specialized centers is justified.

journal_name

Arch Pathol Lab Med

journal_title

Archives of pathology & laboratory medicine

authors

Jedrzkiewicz J,Tateishi Y,Kirsch R,Conner J,Bischof D,McCart A,Riddell R,Pollett A,Taylor EL,Govindarajan A

doi

10.5858/arpa.2019-0214-OA

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

764-768

issue

6

eissn

0003-9985

issn

1543-2165

journal_volume

144

pub_type

杂志文章

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