Blood and lymphatic vessel invasion in pT1 colorectal cancer: an international concordance study.
OBJECTIVE
This study was performed to evaluate the concordance in pathological assessments of blood and lymphatic vessel invasion (BLI) in pT1 colorectal cancers and to assess the effect of diagnostic criterion on consistency in the assessment of BLI.


METHODS
Forty consecutive patients undergoing surgical resection of pT1 colorectal cancers were entered into this study. H&E-stained, D2-40-stained and elastica-stained slides from the tumours were examined by 18 pathologists from seven countries. The 40 cases were divided into two cohorts with 20 cases each. In cohort 1, pathologists diagnosed BLI using criteria familiar to them; all Japanese pathologists used a criterion of BLI from the Japanese Society for Cancer of the Colon and Rectum (JSCCR). In cohort 2, all pathologists used the JSCCR diagnostic criterion.


RESULTS
In cohort 1, diagnostic concordance was moderate in the US/Canadian and European pathologists. There were no differences in the consistency compared with results for Japanese pathologists, and no improvement in the diagnostic concordance was found for using the JSCCR criterion. However, in cohort 2, the JSCCR criterion decreased the consistency of BLI diagnosis in the US/Canadian and European pathologists. The level of decreased consistency in the assessment of BLI was different between the US/Canadian and European pathologists.


CONCLUSIONS
A uniform criterion strongly influences the diagnostic consistency of BLI but may not always improve the concordance. Further study is required to achieve an objective diagnosis of BLI in colorectal cancer. The varying effects of diagnostic criterion on the pathologists from Japan, the USA/Canada and Europe might reflect varied interpretations of the criterion. Internationally accepted criterion should be developed by participants from around the world.
Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan.
Motohiro
M
Kojima
Department of Pathology, HôpitauxUniversitaires de Genève 1, Genève, Switzerland.
Giacomo
G
Puppa
Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
Richard
R
Kirsch
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Olca
O
Basturk
Department of Pathology, Ohio State University Medical Center E-411 Doan Hall, Columbus, Ohio, USA.
Wendy L
WL
Frankel
Institute of Pathology, Bayreuth, Germany.
Michael
M
Vieth
Institute of Pathology, University of Bern, Bern, Switzerland.
Alessandro
A
Lugli
Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland.
Kieran
K
Sheahan
Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA.
Matthew
M
Yeh
Department of Pathology, Gastrointestinal Pathology Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
Greg Y
GY
Lauwers
Department of Pathology, Candiolo Cancer Institute-FPO, IRCCS, Torino, Italy.
Mauro
M
Risio
Department of Pathology, National Defence Medical College, Saitama, Japan.
Hideyuki
H
Shimazaki
Department of Pathology, National Defence Medical College, Saitama, Japan.
Keiichi
K
Iwaya
Department of Diagnostic Pathology, Kurume University Hospital, Fukuoka, Japan.
Masayoshi
M
Kage
Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan.
Jun
J
Akiba
Department of Pathology, Kyorin University Graduate School of Medicine, Tokyo, Japan.
Yasuo
Y
Ohkura
Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Shinichiro
S
Horiguchi
Division of Pathology, Sanin-Rosai Hospital, Tottori, Japan.
Kohei
K
Shomori
Division of Diagnostic Pathology, Shiga University of Medical Science Hospital, Shiga, Japan.
Ryoji
R
Kushima
Biostatistical Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan.
Shogo
S
Nomura
Department of Pathology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan.
Yoichi
Y
Ajioka
Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Volkan
V
Adsay
Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan.
Atsushi
A
Ochiai
D000368:Aged; D001706:Biopsy; D001808:Blood Vessels / Q000473:pathology*; D002170:Canada; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005060:Europe; D005260:Female; D006801:Humans; D007564:Japan; D042601:Lymphatic Vessels / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013194:Staining and Labeling; D014481:United States
CANCER; COLORECTAL CANCER; DIAGNOSTICS