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El-Kefraoui C, Johnson G, Singh H, Helewa RM. Optimal endoscopic localization of colorectal neoplasms: a comparison of rural versus urban documentation practices. World J Surg Oncol 2023; 21:115. [PMID: 36978191 PMCID: PMC10052793 DOI: 10.1186/s12957-023-02987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Colonoscopy is the gold standard for diagnosing colorectal neoplasms. However, colonoscopy is often repeated preoperatively due to non-standard documentation and inconsistent practices by index endoscopists. Repeat endoscopies result in treatment delays and can increase risks of complications. National consensus recommendations were recently developed for optimal endoscopic colorectal lesion localization. We aimed to assess baseline colonoscopy practice differences from the new recommendations with a focus on geographical variability in report quality between urban and rural referral sites. METHODS We performed a retrospective review of patients who underwent elective surgery for colorectal neoplasms at a single institution in Winnipeg between 2007-2020. We compared endoscopy report quality to the national recommendations with charts stratified by endoscopy location. Our primary outcomes were overall report documentation completeness and use of recommended practices. RESULTS One hundred ninety-four patients were included (97 rural, 97 urban). The mean overall compliance with the recommendations for urban endoscopies was marginally better compared to rural endoscopies (50% vs. 48%, p = 0.04). Sixty-eight percent of the reports complied with tattoo indications (72% urban; 63% rural, p = 0.16). On average, reports included 29% of recommended tattoo information (30% urban; 28% rural, p = 0.25) and demonstrated 74% appropriate tattoo technique (70% urban; 81% rural, p = 0.10). Twenty-one percent of reports included photographs of lesions in accordance with the national recommendations (28% urban; 13% rural, p = 0.01). CONCLUSIONS Endoscopists frequently omit recommended practices for optimal colorectal lesion localization. Rural reports miss more recommended information compared to urban reports. Future research is needed to facilitate province-wide high-quality endoscopy reporting for patients regardless of endoscopy location.
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Affiliation(s)
- Charbel El-Kefraoui
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Garrett Johnson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
- Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada
| | - Harminder Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Ramzi M Helewa
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023-409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Maleszewski JJ, Basso C, Burke A, Castonguay M, Leduc C, Tavora F, Sheppard M, Suri R, Judge M, Cooper WA. Dataset for the reporting of neoplasms of the heart, pericardium, and great vessels: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2023; 482:303-309. [PMID: 36512082 DOI: 10.1007/s00428-022-03473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) was founded by major pathology organizations from around the world to produce internationally standardized and evidence-based datasets for pathologists' reporting of cancer. Its goal is to improve cancer patient outcomes worldwide and to advance international benchmarking in cancer management. The ICCR cancer dataset development schedule is aligned with revisions of the WHO Classification of Tumours ("Blue Book") series, and in 2015 ICCR developed an initial series of thoracic datasets including a dataset for neoplasms of the heart, pericardium, and great vessels. This edition has now been updated to align with the 2021 WHO Blue Book series. An expert panel was convened to review and revise the dataset. While the majority of ICCR datasets are focused on malignant tumors, the scope of this dataset includes a number of benign tumors and tumor-like entities because of the rarity of cardiac malignancies and the serious implications of even histologically benign lesions. Due to the rarity of cardiac tumors, evidence in support of reporting elements is limited.
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Affiliation(s)
- Joseph J Maleszewski
- ICCR Dataset for the Reporting of Neoplasms of the Heart, Pericardium, and Great Vessels Dataset Authoring Committee, Department of Laboratory Medicine & Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA.
| | - Cristina Basso
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Allen Burke
- University of Maryland Medical Center, University of Maryland, Baltimore, MD, USA
| | - Mathieu Castonguay
- Department of Pathology, Faculty of Medicine, Dalhousie University Halifax, Halifax, NS, Canada
| | - Charles Leduc
- Department of Pathology, University of Montreal Health Center, Montreal, QC, Canada
| | - Fabio Tavora
- Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Mary Sheppard
- St. George's Medical School, University of London, London, UK
| | - Rakesh Suri
- Division of Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Meagan Judge
- Royal College of Pathologists of Australasia, Surry Hills, New South Wales, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, 2050, Australia.,Discipline of Pathology, School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Tremblay A, Ezer N, Burrowes P, MacGregor JH, Lee A, Armstrong GA, Pereira R, Bristow M, Taylor JL, MacEachern P, Taghizadeh N, Koetzler R, Bedard E. Development and application of an electronic synoptic report for reporting and management of low-dose computed tomography lung cancer screening examination. BMC Med Imaging 2022; 22:111. [PMID: 35690733 PMCID: PMC9188213 DOI: 10.1186/s12880-022-00837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Interpretation of Low Dose CT scans and protocol driven management of findings is a key aspect of lung cancer screening program performance. Reliable and reproducible methods are needed to communicate radiologists’ interpretation to the screening program or clinicians driving management decision.
Methods We performed an audit of a subset of dictated reports from the PANCAN study to assess for omissions. We developed an electronic synoptic reporting tool for radiologists embedded in a clinical documentation system software. The tool was then used for reporting as part of the Alberta Lung Cancer Screening Study and McGill University Health Centre Pilot Lung Cancer Screening Program.
Results Fifty reports were audited for completeness. At least one omission was noted in 30 (70%) of reports, with a major omission (missing lobe, size, type of nodule in report or actionable incidental finding in recommendation section of report) in 24 (48%). Details of the reporting template and functionality such as automated nodule cancer risk assessment, Lung-RADS category assignment, auto-generated narrative type report as well as personalize participant results letter is provided. A description of the system’s performance in its application in 2815 CT reports is then summarized. Conclusions We found that narrative type radiologist reports for lung cancer screening CT examinations frequently lacked specific discrete data elements required for management. We demonstrate the successful implementation of a radiology synoptic reporting system for use in lung cancer screening, and the use of this information to drive program management and communications.
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Affiliation(s)
- Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Nicole Ezer
- Department of Medicine, McGill University Health Centre, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Paul Burrowes
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - John Henry MacGregor
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Andrew Lee
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Gavin A Armstrong
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Raoul Pereira
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Michael Bristow
- Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Jana L Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Paul MacEachern
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Niloofar Taghizadeh
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Rommy Koetzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Eric Bedard
- Department of Surgery, Faculty of Medicine and Dentistry, Walter C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, 2J2.00T6G 2R7, Canada
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Johnson GGRJ, Singh H, Vergis A, Park J, Hershorn O, Hochman D, Helewa RM. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study. Surg Endosc 2021. [PMID: 34101014 DOI: 10.1007/s00464-021-08580-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Repeat preoperative endoscopy is common for patients with colorectal neoplasms. This can result in treatment delays, patient discomfort, and risks of colonoscopy-related complications. Repeat preoperative endoscopy has been attributed to poor communication between endoscopists and surgeons. In January 2019, mandatory electronic synoptic reporting for endoscopy was implemented to include elements consistent with quality indicators proposed in national guidelines. The aim of the present study is to assess whether the repeat preoperative endoscopy rate for colorectal lesions changed following synoptic report implementation. METHODS A retrospective review was performed of 1690 consecutive patients who underwent elective surgical resection for colorectal neoplasms from January 2007 to June 2020 at a tertiary hospital in Canada. Patients who had an index endoscopy documented via synoptic report were compared to those reported via narrative report. Primary outcomes were rates of repeat preoperative endoscopy and inclusion of colonoscopy quality indicators: photo-documentation, tattoo placement, and bowel preparation score. RESULTS In total, 1429 patients who underwent elective colorectal resection for colorectal cancers or polyps between January 2007 and June 2020 were included. 115 had index endoscopies recorded via synoptic report and 1314 by narrative report. The repeat preoperative endoscopy rate after endoscopies documented by narrative report was 29.07% (95% CI 26.63-31.61) and 25.22% (95% CI 17.58-34.17%) for synoptic report. Patients whose index endoscopies where performed by a practitioner other than their operating surgeon had a re-endoscopy rate of 36.03% (95% CI 32.82-39.33%) after narrative report and 38.81% (95% CI 27.14-51.50%) for synoptic report. Rates of tattoo placement, photo-documentation, and reporting of bowel preparation quality were all significantly increased with synoptic reports (p ≤ 0.003). CONCLUSIONS Endoscopy synoptic reports based on current guidelines were not associated with a decrease in rates of repeat pre-operative endoscopy at a high-volume colorectal cancer centre. Future study should examine guideline deficiencies for this purpose and make necessary modifications.
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Ghossein R, Barletta JA, Bullock M, Johnson SJ, Kakudo K, Lam AK, Moonim MT, Poller DN, Tallini G, Tuttle RM, Xu B, Gill AJ. Data set for reporting carcinoma of the thyroid: recommendations from the International Collaboration on Cancer Reporting. Hum Pathol 2020; 110:62-72. [PMID: 32920035 DOI: 10.1016/j.humpath.2020.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/29/2022]
Abstract
Thyroid cancer therapy is increasingly tailored to patients' risk of recurrence and death, placing renewed importance on pathologic parameters. The International Collaboration on Cancer Reporting (ICCR), an organization promoting evidence-based, internationally agreed-upon standardized pathology data sets, is the ideal conduit for the development of a pathology reporting protocol aimed at improving the care of patients with thyroid carcinomas. An international expert panel reviewed each element of thyroid pathology reporting. Recommendations were made based on the most recent literature and expert opinion.The data set uses the most recent World Health Organization (WHO) classification for the purpose of a more clinically and prognostically relevant nomenclature. One example is the restriction of the term minimally invasive follicular carcinoma to tumors with capsular invasion only. It reinforces the already established criteria for blood vessel invasion adopted by the most recent WHO classification and Armed Forces Institute of Pathology fascicle. It emphasizes the importance of the extent of blood vessel invasion and extrathyroid extension to better stratify patients for appropriate therapy. It is the first data set that requires pathologists to use the more recently recognized prognostically powerful parameters of mitotic activity and tumor necrosis. It highlights the importance of assessing nodal disease volume in predicting the risk of recurrence.The ICCR thyroid data set provides the tools to generate a report that will guide patient treatment in a more rational manner aiming to prevent the undertreatment of threatening malignancies and spare patients with indolent tumors the morbidity of unnecessary therapy. We recommend its routine use internationally for reporting thyroid carcinoma histology.
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Affiliation(s)
- Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Martin Bullock
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2 Canada
| | - Sarah J Johnson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, UK
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Centre, Izumi City General Hospital, Izumi, 594-0073, Japan
| | - Alfred K Lam
- Department of Pathology, School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Mufaddal T Moonim
- Department of Histopathology, Guy's & St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - David N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Giovanni Tallini
- Department of Pathology, University of Bologna Medical Center, 40138, Bologna, Italy
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Anthony J Gill
- University of Sydney, Sydney, New South Wales, 2006, Australia; Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Compérat E, Srigley JR, Brimo F, Delahunt B, Koch M, Lopez-Beltran A, Reuter V, Samaratunga H, Shanks JH, Tsuzuki T, van der Kwast T, Varma M, Webster F, Grignon D. Dataset for the reporting of carcinoma of the bladder-cystectomy, cystoprostatectomy and diverticulectomy specimens: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2020; 476:521-34. [PMID: 31915958 DOI: 10.1007/s00428-019-02727-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) is a not for profit organisation whose goal is to produce standardised internationally agreed and evidence-based datasets for pathology reporting. With input from pathologists worldwide, the datasets are intended to be uniform and structured. They include all items necessary for an objective and accurate pathology report which enables clinicians to apply the best treatment for the patient. This dataset has had input from a multidisciplinary ICCR expert panel. The rationale for some items being required and others recommended is explained, based on the latest literature. The dataset incorporates data from the World Health Organization (WHO) 2016, and also from the latest (8th edition) TNM staging system of the American Joint Committee on Cancer (AJCC). Fifteen required elements and eight recommended items are described. This dataset provides all the details for a precise and valuable pathology report required for patient management and prognostication. This dataset is intended for worldwide use, and should facilitate the collection of standardised comparable data on bladder carcinoma at an international level.
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Stogryn S, Hardy KM, Abou-Setta AM, Clouston KM, Metcalfe J, Vergis AS. Advancement in the quality of operative documentation: A systematic review and meta-analysis of synoptic versus narrative operative reporting. Am J Surg 2019; 218:624-630. [PMID: 31130211 DOI: 10.1016/j.amjsurg.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The operative report is vital for patients and central to surgical quality assessment. Narrative operative reports are often poor quality. Synoptic reporting can improve documentation. The objective was to identify and appraise studies comparing synoptic and narrative operative reporting. DATA SOURCES A systematic review of the literature was performed. The primary outcome was completion of critical elements for an operative report. Additional secondary outcomes were measured. Meta-analysis was performed where possible. Quality analysis was performed using Newcastle-Ottawa Scale (NOS). RESULTS 1471 citations were identified; 16 studies included. Mean NOS was 7.09 out of 9 (+/-- SD 1.73). Meta-analysis demonstrated that synoptic reporting was significantly more complete (SMD 1.70, 95% CI 1.13 to 2.26; I2 98%). Completion time was shorter with synoptic reporting (mean difference -0.86, 95% CI -1.17 to -0.55). Secondary outcomes favoured synoptic reporting. CONCLUSIONS Synoptic reporting platforms outperform narrative reporting and should be incorporated into surgical practice.
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Affiliation(s)
- Shannon Stogryn
- University of Manitoba, Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Surgery; St. Boniface Hospital, Z3039-409 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - Krista M Hardy
- University of Manitoba, Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Surgery; St. Boniface Hospital, Z3039-409 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - Ahmed M Abou-Setta
- Rady Faculty of Health Sciences, Max Rady College of Medicine, George and Fay Yee Centre for Healthcare Innovation-Knowledge Synthesis Unit and Review, Third Floor, Chown Building, 753 McDermot Avenue, University of Manitoba, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Kathleen M Clouston
- University of Manitoba, Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Surgery; St. Boniface Hospital, Z3039-409 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - Jennifer Metcalfe
- University of Manitoba, Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Surgery; St. Boniface Hospital, Z3039-409 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada.
| | - Ashley S Vergis
- University of Manitoba, Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Surgery; St. Boniface Hospital, Z3039-409 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada.
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