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The 2010 WHO classification of digestive neuroendocrine neoplasms: a critical appraisal four years after its introduction.

https://arctichealth.org/en/permalink/ahliterature260854
Source
Endocr Pathol. 2014 Jun;25(2):186-92
Publication Type
Article
Date
Jun-2014
Author
G. Rindi
G. Petrone
F. Inzani
Source
Endocr Pathol. 2014 Jun;25(2):186-92
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Digestive System Neoplasms - classification
Humans
Neoplasm Grading - standards
Neoplasm Staging - standards
Neuroendocrine Tumors - classification
World Health Organization
Abstract
This paper briefly illustrates the basis, rules of application, and present outcome of the current World Health Organization (WHO) classification for neuroendocrine neoplasms. Established in 2010 upon the proposal from the European Neuroendocrine Tumor Society (ENETS), the WHO 2010 fostered some definitional changes (most notably the use of neuroendocrine tumor (NET) instead of carcinoid) and indicated the tools of grading and staging. Specific rules for its application were also defined. The data generated from the use of WHO 2010 classification substantially endorsed its rules and prognostic efficacy. In addition, the application demonstrated some issues, among which are the possible re-definition of the cutoff for grading G1 vs G2, as well as the possible identification of cases with somewhat different clinical behavior within the G3 neuroendocrine cancer class. Overall, since the recent introduction of WHO 2010 grading and staging, it appears wise to keep the current descriptors to avoid unnecessary confusion and to generate comparable data. Homogenous data on large series are ultimately needed to solve such issues.
PubMed ID
24699927 View in PubMed
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Canadian Council on Health Services Accreditation: client-centred cancer staging standards.

https://arctichealth.org/en/permalink/ahliterature200993
Source
Cancer Prev Control. 1998 Dec;2(6):295-8
Publication Type
Article
Date
Dec-1998
Author
M. Colton
Author Affiliation
Primary, Acute and Continuing Care, Canadian Council on Health Services Accreditation. colm@cchsa.ca
Source
Cancer Prev Control. 1998 Dec;2(6):295-8
Date
Dec-1998
Language
English
Publication Type
Article
Keywords
Accreditation
Canada
Consumer Satisfaction
Data Collection
Forecasting
Health services
Humans
Neoplasm Staging - standards
Organizations
Quality of Health Care
Abstract
The Canadian Council on Health Services Accreditation has a mission to promote excellence in the provision of quality health care and the efficient use of resources in health organizations throughout Canada. The products and services of the CCHSA include national standards, onsite surveys and field education. The present standards of this voluntary, nonprofit national organization recognize the importance of cancer staging as an activity to evaluate the extent of disease in cancer patients and require cancer stage to be recorded. The CCHSA is implementing the next generation of accreditation, the Achieving Improved Measurement (AIM) project, which will lead to improved measurement of quality of health care. These quality-improvement efforts will emphasize the process of recording and reporting the TNM stage in all appropriate new cases of cancer.
PubMed ID
10470459 View in PubMed
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Capturing tumour stage in a cancer information database.

https://arctichealth.org/en/permalink/ahliterature200991
Source
Cancer Prev Control. 1998 Dec;2(6):304-9
Publication Type
Article
Date
Dec-1998
Author
W K Evans
J. Crook
D. Read
J. Morriss
D M Logan
Author Affiliation
Ottawa Regional Cancer Centre, Cancer Care Ontario. bevans@cancercare.on.ca
Source
Cancer Prev Control. 1998 Dec;2(6):304-9
Date
Dec-1998
Language
English
Publication Type
Article
Keywords
Accreditation
Attitude of Health Personnel
Cancer Care Facilities
Databases, Factual
Female
Hospital Information Systems
Humans
Male
Medical Oncology
Medical Records
Neoplasm Staging - standards
Ontario
Prospective Studies
Registries
Retrospective Studies
Abstract
1. To present the steps taken and lessons learned from one cancer centre's efforts to capture tumour stage information in a cancer database. 2. To determine the accuracy of the stage data through a chart audit. 3. To describe the potential uses of stage information in a cancer centre.
This is a retrospective review of an initiative to capture tumour stage information at a regional cancer centre in Ontario.
The minutes of the centre's Health Records and Medical Advisory Committees related to staging were reviewed. Data on stage by tumour type was extracted from the centre's Oncology Patient Information System (OPIS). Three hundred and ninety charts were analysed to assess the accuracy of stage information and identify staging errors. Health Information Services workload statistics were reviewed to determine the types and frequency of projects undertaken using stage-related data.
In January 1994, the Ottawa Regional Cancer Centre introduced policies and procedures to capture stage-related information. Standardized staging forms and a physician reminder system encouraged the centre's physicians to record tumour stage within 3 months of new patient registration. Of all qualifying cases in 1994, 92% were staged. A medical audit in 1998 of 390 charts from the 3 previous years of staging data revealed that 71.5% of the charts reviewed had been staged completely. Of the incompletely staged cases, 19% to 57% had TNM recorded, but the stage grouping was not recorded, or the "stage" was the extent of disease at the time of disease progression rather than at initial diagnosis (35% to 71%). Physician-related staging errors occurred in 2% to 5% of cases; data-entry errors occurred in 3% to 6% of cases.
Stage information has enabled the centre to better describe its patient clientele for accreditation purposes and to assist researchers in estimating the number of patients potentially available for prospective and retrospective studies. It is being used to guide targeted educational initiatives to selected populations in the region's catchment area and assists administrators in estimating resource needs. Resistance to the capture of stage information can be overcome with persistence, the development of procedures that facilitate physician compliance, including a reminder system, the development of institutional policies and procedures and by feedback on the uses and availability of stage information.
PubMed ID
10470461 View in PubMed
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Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study.

https://arctichealth.org/en/permalink/ahliterature16571
Source
Cancer. 2006 Feb 1;106(3):524-31
Publication Type
Article
Date
Feb-1-2006
Author
Catharina Ihre Lundgren
Per Hall
Paul W Dickman
Jan Zedenius
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. cia.ihre-lundgren@ki.se
Source
Cancer. 2006 Feb 1;106(3):524-31
Date
Feb-1-2006
Language
English
Publication Type
Article
Keywords
Adenocarcinoma, Follicular - mortality - pathology - surgery
Adult
Aged
Aged, 80 and over
Carcinoma, Papillary - mortality - pathology - surgery
Case-Control Studies
Diagnosis, Differential
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging - standards
Prognosis
Registries - statistics & numerical data
Research Support, Non-U.S. Gov't
Risk assessment
Thyroid Neoplasms - mortality - pathology - surgery
Abstract
BACKGROUND: Different scoring systems currently are being used to stratify patients with differentiated thyroid carcinoma (DTC) into risk groups. DTC is usually subdivided into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). The objective of the current study was to identify those factors that predict long-term unfavorable prognosis and to evaluate the predictive accuracy of the TNM staging system. METHODS: The authors conducted a nested case-control study within the cohort of all patients (n=5123) diagnosed with DTC in Sweden between 1958-1987 who survived at least 1 year after diagnosis. One control, matched by age at diagnosis, gender, and calendar period, was randomly selected for each case (patients who died of DTC). All patients were classified at the time of diagnosis according to the TNM staging system. The effect of prognostic factors on DTC mortality was evaluated using conditional logistic regression. RESULTS: Patients with widely invasive FTC experienced a significantly higher mortality compared with PTC patients. The grade of differentiation was found to influence mortality significantly. Patients with TNM Stage IV disease had a higher mortality rate compared with patients with Stage II disease (odds ratio [OR]=9.1; 95% confidence interval [95% CI], 5.7-14.6). Patients with lymph node metastases experienced a higher mortality (OR=2.5; 95% CI, 1.6-4.1) and patients with distant metastasis at the time of diagnosis were found to have a nearly 7-fold higher mortality rate (OR=6.6; 95% CI, 4.1-10.5). Incomplete surgical excision was associated with higher mortality, particularly in patients with Stage I disease. CONCLUSIONS: In the current study, the following were found to be clinically significant prognostic factors for patients with DTC: histopathologic subgroup, TNM staging including lymph node metastases and distant metastases, and completeness of the surgical excision.
PubMed ID
16369995 View in PubMed
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Controversies in prostate cancer staging implementation at a tertiary cancer center.

https://arctichealth.org/en/permalink/ahliterature165958
Source
Can J Urol. 2006 Dec;13(6):3327-34
Publication Type
Article
Date
Dec-2006
Author
Tracy Sexton
George Rodrigues
Ed Brecevic
Laura Boyce
Denise Parrack
Michael Lock
David D'Souza
Author Affiliation
Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Center, London, Ontario, Canada.
Source
Can J Urol. 2006 Dec;13(6):3327-34
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Canada
Cancer Care Facilities
Humans
Male
Medical Audit
Neoplasm Staging - standards
Prostatic Neoplasms - pathology
Quality Assurance, Health Care
Registries
Retrospective Studies
Abstract
To assess accuracy of recorded prostate cancer stage after implementation of a quality assurance staging improvement plan.
Genitourinary multidisciplinary TNM staging guidelines were prospectively implemented. Educational programs for health records technicians (HRT) and clinicians preceded implementation of the new guidelines. Patient stage information was entered into the Oncology Patient Information System (OPIS) as part of the usual operations of the cancer center by an HRT. Physician and HRT auditors performed a subsequent quality assurance audit on 97 prostate cancer patients seen over a 2-month period. Assessment of staging accuracy and reasons for discrepancies between the OPIS stage and auditor stage were analyzed and reported.
Fifty-four (52%) charts showed discrepancies between auditors. Of the fifty-four, twelve (22%) had discrepancies between OPIS and auditor, thirty (56%) showed discrepancies between auditors, and twelve (22%) had discrepancies between OPIS, physician auditor, and HRT auditor. Forty-three (41%) cases had no discrepancies. Reasons for discrepancies included: misinterpretation of the digital rectal examination (16/54), inappropriate use of TRUS/MRI (9/54) in staging, stage not assigned at initial diagnosis (9/54), misinterpretation of pathology (7/54), TNM staging confusion (4/54), OPIS update not performed (3/54), inappropriate use of biopsy data (3/54), disagreement between consultants (2/54), and misinterpretation of TURP result (1/54). Overall staging accuracy was 76% for OPIS, 65% for the physician auditor and 62% for the HRT auditor.
Despite guidelines and educational interventions, computer registry staging accuracy remains an issue. On-going audit procedures are proposed to identify and correct both published and institutional staging guidelines.
PubMed ID
17187696 View in PubMed
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Hodgkin's disease in Denmark. A national clinical study by the Danish Hodgkin Study Group, LYGRA.

https://arctichealth.org/en/permalink/ahliterature27316
Source
Scand J Haematol. 1980 Apr;24(4):321-34
Publication Type
Article
Date
Apr-1980
Source
Scand J Haematol. 1980 Apr;24(4):321-34
Date
Apr-1980
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Denmark
Female
Hodgkin Disease - epidemiology - mortality - therapy
Humans
Infant
Leukemia, Myelocytic, Acute - epidemiology
Lymph Nodes - pathology
Lymphography
Male
Middle Aged
Neoplasm Staging - standards
Pneumococcal Infections - epidemiology - etiology
Postoperative Complications
Prognosis
Splenectomy - adverse effects
Abstract
During the last 8 years (1971-1979) all newly diagnosed previously untreated patients with Hodgkin's disease in Denmark have been centralized to uniform staging procedures and treatment. A total of 802 patients were registered, or 2 patients/100 000. Lymphangiography was performed in 708 patients (88%), and 437 patients (55%) underwent laparotomy with splenectomy. Treatment included radiotherapy, combination chemotherapy (MOPP or similar programmes), and combined modality treatment. The overall 8-year actuarial survival for all stages combined was 66%, and relapse-free survival was 55%. 144 patients died of Hodgkin's disease, 23 from complications to therapy and examination procedures, and 54 died of unrelated causes. Survival was significantly better for patients without B-symptoms, and decreased gradually with advancing age. There was a strong correlation between unfavourable prognosis and advancing stage and/or histology, but mediastinal involvement had no influence upon the prognosis. Staging laparotomy was associated with 4 deaths due to infection, and splenectomy with 10 cases of severe pneumococcal infections, 4 of which were fatal. Fatal complications due to subsequent treatment included 2 cases of cardiac arrest following mantle-field irradiation and 3 cases of haemorrhage or sepsis following chemotherapy. 5 cases of acute myeloid leukaemia were observed.
PubMed ID
6932097 View in PubMed
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Neuroendocrine tumors of the colon and rectum: prognostic relevance and comparative performance of current staging systems.

https://arctichealth.org/en/permalink/ahliterature118405
Source
Ann Surg Oncol. 2013 Apr;20(4):1170-8
Publication Type
Article
Date
Apr-2013
Author
Ryaz Chagpar
Yi-Ju Chiang
Yan Xing
Janice N Cormier
Barry W Feig
Asif Rashid
George J Chang
Y Nancy You
Author Affiliation
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Source
Ann Surg Oncol. 2013 Apr;20(4):1170-8
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Aged
Colonic Neoplasms - classification - mortality - pathology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Invasiveness
Neoplasm Metastasis
Neoplasm Staging - standards
Neuroendocrine Tumors - classification - mortality - secondary
Prognosis
Rectal Neoplasms - classification - mortality - pathology
Registries
Survival Rate
Abstract
With increasing interest in neuroendocrine tumors (NETs), three staging systems for NETs of the colon and rectum have been published. Their prognostic relevance has not been examined and compared in an independent clinical database.
From the National Cancer Database (NCDB), 5457 patients diagnosed with colorectal neuroendocrine tumor (CRNETs) between 1998 and 2002 were staged according to the staging systems from (1) European Neuroendocrine Tumor Society (ENETS, 2006; n = 1537); (2) American Joint Committee on Cancer (AJCC, 2009; n = 1140); and (3) location-specific staging systems from the Surveillance Epidemiology and End Results (SEER, 2008; n = 942). Stage-stratified overall survival (OS) and Cox-specific concordance indices were calculated for each system. Independent prognostic factors were identified by multivariate analysis.
Five-year OS for stage I, II, III, and IV CRNETs as defined by the ENETS staging system were 90.8, 77.3, 53.1, and 14.8 %, respectively. For well-differentiated CRNETs, the 5-year OS for stage I, II, III, and IV as defined by the AJCC staging system were superior: 90.6, 83.9, 64.8, and 24.9 %, respectively. Both staging systems had a concordance index of 0.72. After specifying location in the colon versus rectum, all three systems demonstrated acceptable performance. Histologic grade was a significant independent predictor of OS not currently incorporated in the staging systems.
The three staging systems showed comparable prognostic stratification of CRNETs, while the AJCC and ENETS systems are the most parsimonious. The current analysis supports the use of the AJCC for well-differentiated disease and ENETS systems for all CRNETs until there is further evidence for modification.
PubMed ID
23212760 View in PubMed
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Pretreatment staging of colon cancer in the Swedish population.

https://arctichealth.org/en/permalink/ahliterature258049
Source
Colorectal Dis. 2013 Nov;15(11):1361-6
Publication Type
Article
Date
Nov-2013
Author
A. Sjövall
L. Blomqvist
A. Martling
Author Affiliation
Center of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
Source
Colorectal Dis. 2013 Nov;15(11):1361-6
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - radiography - secondary - surgery
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Colonic Neoplasms - pathology - radiography - surgery
Emergencies
Female
Guideline Adherence - statistics & numerical data
Humans
Liver Neoplasms - diagnosis - secondary
Lung Neoplasms - diagnosis - secondary
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Staging - standards - statistics & numerical data
Practice Guidelines as Topic
Preoperative Period
Surgical Procedures, Elective - statistics & numerical data
Sweden
Tomography, X-Ray Computed
Young Adult
Abstract
Preoperative staging of colon cancer according to Swedish national guidelines implies imaging evaluation of the primary tumour, liver and lungs. Failure to adhere to these guidelines results in negative scorings in the national registration system. In the present study we report the extent of compliance with these guidelines.
Since 2007 clinical data on all patients diagnosed with colon cancer in Sweden have been collected in a national database. This includes information on pretherapeutic diagnostic imaging performed, pretherapeutic TNM stage and data on treatment and follow-up. All patients diagnosed with colon cancer in Sweden between 2007 and 2010 were included.
Nine thousand and eight-three patients (i.e. 60.5% of all patients) had a complete pretherapeutic radiological evaluation; 65.2% had a CT or MRI of the primary tumour, whereas over 80% had examinations of the liver and lungs. There were no difference related to sex, but more patients under 75 years had a complete evaluation. There were large differences between different regions; one region performed a complete evaluation of 78.3% of all patients. The proportion of patients examined increased from 53.9 to 65.0% during the study period. Elective cases were more frequently evaluated before treatment than those with an emergency presentation.
Most patients in Sweden had a complete pretreatment imaging evaluation of the colon cancer with geographical and time-dependent variations. Knowledge of the importance of these variations and correlation of pre- and postoperative TNM stage is warranted, and such studies are ongoing.
PubMed ID
23773574 View in PubMed
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Staging practice for prostate cancer varies and is not in line with clinical guidelines.

https://arctichealth.org/en/permalink/ahliterature280940
Source
Dan Med J. 2016 Dec;63(12)
Publication Type
Article
Date
Dec-2016
Author
Lars J Petersen
Yuliya Shuytsky
Helle D Zacho
Source
Dan Med J. 2016 Dec;63(12)
Date
Dec-2016
Language
English
Publication Type
Article
Keywords
Bone Neoplasms - diagnostic imaging - secondary
Denmark
Guideline Adherence - trends
Humans
Magnetic Resonance Imaging
Male
Neoplasm Grading
Neoplasm Staging - standards
Practice Guidelines as Topic
Prospective Studies
Prostate-Specific Antigen - blood
Prostatic Neoplasms - blood - pathology
Surveys and Questionnaires
Tomography, Emission-Computed, Single-Photon
Tomography, X-Ray Computed
Abstract
The objective was to describe regional variations in M-staging in patients with newly diagnosed prostate cancer within a Danish county and to compare clinical practice with guideline recommendations.
Data were as captured from 1) a prospective, non-interventional study counting 635 consecutive patients referred for M-staging in the 2008-2009 period at three regional hospitals within one county, and 2) a questionnaire on M-staging practice completed by the five sites performing M-staging in the same county in 2015.
All three sites referred patients for M-staging in 2008, irrespective of their risk factors. Two of the three sites maintained this practice in 2015. Furthermore, in 2015, three of five sites performed M-staging in intermediate and high-risk patients only. Planar whole-body bone scans were standard in all sites in 2008 with single photon emission computed tomography/computed tomography (SPECT/CT) being performed if required and if available. In 2015, two sites used choline positron emission tomography/CT for primary staging of high-risk patients against guideline recommendations. The use of SPECT/CT showed wide variations from "if required" to "mandatory" head-to-thigh imaging. There were notable variations between clinical practice and guidelines in 2008, and this was even more evident in 2015.
Considerable variations existed with respect to the M-staging imaging practices in prostate cancer within a single Danish county. The variation was more pronounced in 2015 than in 2008. Clinical practice conflicted in part with European and national Danish guidelines.
none.
not relevant.
PubMed ID
27910797 View in PubMed
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Surgeons' knowledge of quality indicators for gastric cancer surgery.

https://arctichealth.org/en/permalink/ahliterature159715
Source
Gastric Cancer. 2007;10(4):205-14
Publication Type
Article
Date
2007
Author
Lucy K Helyer
Catherine O'Brien
Natalie G Coburn
Carol J Swallow
Author Affiliation
Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
Source
Gastric Cancer. 2007;10(4):205-14
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Clinical Competence
Combined Modality Therapy
Female
Gastrectomy - standards
General Surgery - standards
Humans
Lymph Node Excision - standards
Male
Middle Aged
Neoplasm Staging - standards
Ontario
Palliative Care
Physicians - standards
Quality Indicators, Health Care
Questionnaires
Stomach Neoplasms - surgery - therapy
Abstract
Gastric cancer survival in the West is inferior to that achieved in Asian centers. While differences in tumor biology may play a role, poor quality surgery likely contributes to understaging. We hypothesize that the majority of surgeons performing gastric cancer surgery in North America are unaware of the recommended standards.
Using the Ontario College of Physicians and Surgeons registry, surgeons who potentially included gastric cancer surgery in their scope of practice were identified. A questionnaire was mailed to 559; of those, 206 surgeons reported managing gastric cancer. Results were evaluated by chi(2) and logistic regression; P
PubMed ID
18095075 View in PubMed
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13 records – page 1 of 2.