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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2019

01-08-2019 | Pathology | Peritoneal Surface Malignancy

Discordant Diagnostic Terminology and Pathologic Grading of Primary Appendiceal Mucinous Neoplasms Reviewed at a High-Volume Center

Authors: Haroon A. Choudry, MD, Reetesh K. Pai, MD, Anoosh Parimi, MD, Heather L. Jones, MPA-C, James F. Pingpank, MD, Steven S. Ahrendt, MD, Matthew P. Holtzman, MD, David L. Bartlett, MD

Published in: Annals of Surgical Oncology | Issue 8/2019

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Abstract

Background

Diagnostic terminology and grading of primary appendiceal mucinous neoplasms lacks uniformity. We sought to identify discordance in pathologic reporting by reviewing pathology slides for cases referred to our institution.

Methods

Using guidelines from Peritoneal Surface Oncology Group International (PSOGI) and American Joint Committee on Cancer 8th edition (AJCC8), we compared diagnostic terminology/grading of primary appendiceal mucinous neoplasms (n = 115) between pathology reports from referring institutions and review of slides by pathologists at our high-volume institution.

Results

There was discordance in pathologic terminology and grading of primary appendiceal mucinous neoplasms between referring institutions and our institution in 28% and 50% of patients, respectively. In particular, 24% of patients referred with mucinous adenocarcinoma (MACA) had LAMN on our review, and a higher grade MACA was found in 48% of patients referred with low-grade (G1) MACA and 16% of patients referred with high-grade (G2) MACA following our review. Discordance in tumor grade between primary and metastatic disease was seen in 19% of cases based on referred primary tumor grading compared with only 4% following our review. Systemic chemotherapy was unnecessarily administered to four cases of LAMN (6%) and inappropriately not administered to four cases of MACA (6%) before referral due to inaccurate diagnosis/grading by referring institutions.

Conclusions

We found significant discordance in diagnostic terminology/grading of primary appendiceal mucinous neoplasms following review of referred cases. Inaccurate pathologic assessment was associated with overtreatment or undertreatment with chemotherapy. These data highlight the need for pathologic review of such rare cases at high-volume centers.
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Metadata
Title
Discordant Diagnostic Terminology and Pathologic Grading of Primary Appendiceal Mucinous Neoplasms Reviewed at a High-Volume Center
Authors
Haroon A. Choudry, MD
Reetesh K. Pai, MD
Anoosh Parimi, MD
Heather L. Jones, MPA-C
James F. Pingpank, MD
Steven S. Ahrendt, MD
Matthew P. Holtzman, MD
David L. Bartlett, MD
Publication date
01-08-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07447-z

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