Endoscopy 2019; 51(04): S14
DOI: 10.1055/s-0039-1681209
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Colon ESD South Hall 2B
Georg Thieme Verlag KG Stuttgart · New York

PATHOLOGICAL “SECOND-LOOK” SIGNIFICANTLY ALTERS CLINICAL MANAGEMENT IN ENDOSCOPICALLY RESECTED PT1 COLORECTAL CANCER

G Antonelli
1   Digestive Endoscopy Unit, St. Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
,
GL Rampioni Vinciguerra
2   Pathology Unit, Sant'Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
,
G Berardi
3   General Surgery Unit, Sant'Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
,
G Vanella
1   Digestive Endoscopy Unit, St. Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
,
S Angeletti
1   Digestive Endoscopy Unit, St. Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
,
E Pilozzi
2   Pathology Unit, Sant'Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
,
E Di Giulio
1   Digestive Endoscopy Unit, St. Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Clinical management of endoscopically resected pT1 colorectal cancers (CRC) is still under debate. Guidelines prudentially suggest subsequent surgery in presence of one or more histological factors linked to increased risk of LNM, but a great variability in histological analysis, LNM rates and clinical management has been reported. Lack of standardization and interobserver variability in reporting histological factors may explain this heterogeneity. This kind of pitfall has been overcomed in surveillance of Barrett's Esophagus, with systematical pathological second opinion, recommended by international guidelines. In pT1-CRC, pathologist second opinion is rarely reported, although “European CRC screening Guidelines” suggest its employment, especially when surgical resection is considered. Main aim of our study was to assess how second opinion of an expert GI pathologist may affect clinical management of pT1-CRC.

Methods:

We reviewed data of 83 patients undergoing primary endoscopic resection of pT1-CRC in our center from June 2006 to December 2017. Clinical, histopathological, endoscopic, eventual subsequent surgery and follow up data were collected. Pathological specimens were recovered, and evaluated by a second GI pathologist, blinded to the primary diagnosis. When uncertain, opinion of a third pathologist was sought to achieve a final diagnosis.

Results:

Of 83 pT1-CRCs resected endoscopically, second-look modified diagnosis in 16/83 (19,2%) patients, seemingly exposing them to suboptimal clinical choices. In 9/16 patients that were originally classified as harbouring a low-risk polyp, at least one overlooked histological risk factor was found, shifting them in high-risk group, with a much higher risk of LNM. By contrast, 7/16 polyps were downgraded to low-risk, as second-look did not encounter any risk factor, potentially exposing them to unnecessary surgery.

Conclusions:

Almost 20% of endoscopically resected pT1-CRCs in daily clinical practice would benefit by histopathological second-look, that can significantly modify clinical management, and permit a more accurate risk stratification. Systematic implementation of this practice may be auspicable.