[Download] "Protocol for the Examination of Specimens from Patients with Primary Carcinomas of the Colon and Rectum (Letters to the Editor) (Letter to the Editor)" by Archives of Pathology & Laboratory Medicine ~ Book PDF Kindle ePub Free
eBook details
- Title: Protocol for the Examination of Specimens from Patients with Primary Carcinomas of the Colon and Rectum (Letters to the Editor) (Letter to the Editor)
- Author : Archives of Pathology & Laboratory Medicine
- Release Date : January 01, 2009
- Genre: Health & Fitness,Books,Health, Mind & Body,
- Pages : * pages
- Size : 229 KB
Description
To the Editor.--The recent article by Washington and colleagues (1) presents an updated protocol for the reporting of colorectal carcinomas (CRC) that is based upon the 6th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) TNM Classification of Malignant Tumours (2) for the staging of cancer. The 6th edition of the TNM Classification has attracted some critical comment with regard to CRC, mainly in relation to its proposals for the interpretation of subserosal tumor nodules as lymph node metastases or perivascular/perineural deposits. (3-5) We would like to draw attention to an additional alteration in the current updated protocol, (1) namely a change in the substaging of pT4 tumors in relation to previous recommendations and protocols. Surprisingly, this change is not discussed in the text or in the corresponding protocol recently published on the College of American Pathologists (CAP) Web site. (6) Furthermore, in our opinion, there persists some confusion regarding the assessment of serosal/peritoneal invasion in CRC generally, which we would like to address. On the first point, the most advanced histologic category for local invasion by CRC (pT4) has been subdivided previously into those tumors showing invasion of other organs or structures and those cases that involve or penetrate (previously termed perforate) the visceral peritoneum. In former guidelines, (7-9) these have been classified as T4a and T4b, respectively. In contrast, in the current report, (1) direct invasion of other organs and structures is classified as stage T4b, while penetration of the visceral peritoneum is classified as stage T4a. No comment is made regarding this alteration and, therefore, it is not clear on what basis this adjustment to the staging system has been made. Previous guidelines and related review articles (7-12) have commented that invasion of the visceral peritoneum indicates a worse prognosis than direct invasion of other structures. In our opinion, the evidence supporting this assertion is limited (as discussed in more detail below). However, if true, then it would seem more consistent with the principles of tumor staging that the more adverse finding (ie, visceral peritoneal invasion) would have the higher stage classification (ie, T4b). Thus, the new staging classification appears both unjustified and illogical.
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