1168P - Does specialist centre histopathology review of gastrointestinal neuroendocrine tumours affect clinical management?

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Neuroendocrine Cancers
Pathology/Molecular Biology
Presenter Sarah Bowen Jones
Authors S.C. Bowen Jones, L. Foster, J.W. Valle, W. Mansoor, R. Hubner, B. Chakrabarty
  • Histopathology, The Christie NHS Foundation Trust, M20 4BX - Manchester/UK

Abstract

Introduction

Gastroenteropancreatic Neuroendocrine Tumours (GEP NET) are uncommon tumours occurring at all sites within the gastrointestinal tract. The behaviour of these tumours is difficult to predict and they have been subject to numerous changes in classification and grading systems. In the UK the National Institute for Clinical Excellence recommends centralised histopathology review of these tumours by a member of the NET tumour board. We aimed to determine the frequency of discrepancies between local and central histopathology that could impact clinical management.

Methods

We identified 86 cases of suspected GEP NET referred for specialist histopathology review at the regional network centre from January 2010 to April 2012. Cases were identified by a SnoMed search for cases coded under various endocrine tumour designations and by cross referencing with patient lists from multidisciplinary team meetings. Details of the local and network centre pathology reports were compared. The reports were also judged for compliance with the UK Royal College of Pathologists minimum dataset.

Results

There was complete diagnostic agreement in 54 cases (63%). Discrepancies occurred in the remaining 32 cases (37%), including, 18 differences in grade or proliferation index score (21%), 16 differences in nomenclature (19%), 6 differences in stage (7%) and 5 differences in assessment of perineural or vascular invasion (6%). In 9 cases (10%) an original diagnosis of endocrine tumour was changed to a different type of tumour without endocrine differentiation or vice versa following review. Twenty-six of the overall discrepancies (30% of the total cases) had the potential to meaningfully impact on clinical management. In addition, neither tumour grade nor proliferation index were recorded in 15 local pathology reports (17%), which would necessitate additional pathological analysis prior to clinical decision making. There was full adherence to the minimum dataset in only 19 cases (42% of resections).

Conclusions

This study highlights the importance of specialist centre histopathology review of GEP NET to ensure these patients receive the appropriate clinical management.

Disclosure

All authors have declared no conflicts of interest.