Pathologist second opinion significantly alters clinical management of pT1 endoscopically resected colorectal cancer

• Published in: Virchows Archiv : an international journal of pathology Vol. 475; no. 5; pp. 665 - 668
• Main Authors: Rampioni Vinciguerra, Gian Luca, Antonelli, Giulio, Citron, Francesca, Berardi, Giammauro, Angeletti, Stefano, Baldassarre, Gustavo, Vecchione, Andrea, Di Giulio, Emilio, Pilozzi, Emanuela
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2019; Springer Nature B.V
• Subjects: Brief Report; Cancer; Colorectal cancer; Colorectal carcinoma; Evaluation; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Metastases; Metastasis; Parameter modification; Pathology; Risk analysis; Risk assessment; Risk factors; Risk perception; Subgroups; Tumors; Lymph node metastasis; Early colorectal carcinoma; Second opinion; Colorectal carcinoma; Prognostic factors
• ISSN: 0945-6317; 1432-2307; 1432-2307
• DOI: 10.1007/s00428-019-02603-y

We retrospectively collected a series of 82 endoscopically removed early colorectal cancers. Histological specimens were revised by two gastrointestinal pathologists, performing a re-evaluation of all risk factors for lymph node metastasis. The comparison between second opinion and first pathological report revealed that lymphovascular invasion and tumor grading showed a lower level of concordance than other parameters. Our results demonstrated that second opinion modified risk assessment in about 10% of cases. It was mainly due to a lack in reporting of some parameters at the first diagnosis and a different evaluation in second opinion for updated guidelines. Considering the subgroup of patients with modified risk assessment, clinical data revealed that tumors, re-classified as low risk, did not develop lymph node metastasis that, conversely, occurred in patients identified as high risk by second opinion. In conclusion, second opinion significantly alters risk perception of endoscopically removed early colorectal carcinomas representing a valuable tool for their appropriate clinical management.