Zane Cohen Clinical Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Clin Pathol. 2011 Nov;64(11):983-9. doi: 10.1136/jclinpath-2011-200156. Epub 2011 Jun 22.
Venous invasion (VI) is a known independent prognostic indicator of recurrence and survival in colorectal cancer. The guidelines of the Royal College of Pathologists (RCPath) state that, in a series of resections, extramural VI should be detected in at least 25% of specimens. However, there is widespread variability in the reported incidence, and this may affect patient access to adjuvant therapy. This study aims to clarify the current practice patterns of pathologists regarding the assessment of VI and to identify factors associated with an increased self-reported VI detection rate.
A population-based survey was mailed to 361 pathologists in the province of Ontario, Canada.
The overall response rate was 64.9%. Most pathologists were practicing in community-based centres (66.2%) and approximately half had been in practice for over 15 years (53.5%). A subspecialist interest in gastrointestinal (GI) pathology was declared by 27.3% of pathologists. The majority of pathologists (70.2%) reported that they detected VI in less than 10% of resection specimens, with only 9.1% reporting VI detection rates above 20%. Standardised reporting criteria were applied by 62.1%. Special stains were employed by 57.6% if VI was suspected on H&E-stained sections. Practice in a university-affiliated centre, a subspecialist interest in GI pathology and the acceptance of the 'orphan arteriole' sign were all independently associated with a self-reported VI detection rate above 10% on multivariate analysis.
Self-reported VI detection rates are low among most pathologists. Even among specialist GI pathologists practicing in university-affiliated centres, few reported a detection rate close to that recommended by the RCPath. Strategies to increase the detection of VI may be required.
静脉侵犯（VI）是结直肠癌复发和生存的已知独立预后指标。皇家病理学院（RCPath）的指南规定，在一系列切除术中，至少应在 25%的标本中检测到壁外 VI。然而，报告的发病率存在广泛的差异，这可能会影响患者接受辅助治疗的机会。本研究旨在阐明病理学家评估 VI 的当前实践模式，并确定与自我报告 VI 检出率增加相关的因素。
对加拿大安大略省的 361 名病理学家进行了基于人群的调查，并邮寄了调查问卷。
总的回复率为 64.9%。大多数病理学家在社区中心工作（66.2%），约一半的病理学家从业时间超过 15 年（53.5%）。27.3%的病理学家表示对胃肠道（GI）病理学有专业兴趣。大多数病理学家（70.2%）报告称，他们在不到 10%的切除标本中检出 VI，只有 9.1%的病理学家报告 VI 检出率超过 20%。62.1%的病理学家应用了标准化报告标准。如果在 H&E 染色切片上怀疑存在 VI，则 57.6%的病理学家会使用特殊染色。在大学附属医院工作、对 GI 病理学有专业兴趣以及接受“孤儿动脉”征，在多变量分析中均与自我报告 VI 检出率高于 10%独立相关。
大多数病理学家自我报告的 VI 检出率较低。即使在大学附属医院工作的专业胃肠病理学家中，也很少有报告的检出率接近 RCPath 建议的水平。可能需要采取策略来提高 VI 的检出率。
