Enhanced biomedical scientist cut-up role in colonic carcinoma; preliminary performance data and comparison with departmental performance. E. J. V. Simmons*1, D. S. A. Sanders1, A. Smith1, P. Murphy2, M. Osborne 2, K. Busby2, M. Stellakis2, J. Francombe2. 1Department of Histopathology, 2Department of Surgery, Warwick Hospital, Warwick, United Kingdom

INTRODUCTION: The extended Biomedical Scientist (BMS) role in surgical cut up is increasing in importance and is likely to continue to do so. It allows more efficient use of Consultant time and resources and provides additional career progression for a highly skilled workforce. As the remit of BMS cut up expands to include major cancer resection specimens, it becomes essential, on grounds of quality assurance, to apply the same performance criteria as are applied to specimens dealt with by Consultant and trainee histopathologists. These criteria, and recommendations for what values indicate adequate pathology reporting, are included in the recently published second edition of the RCPath colorectal cancer dataset 3. These criteria, namely number of lymph nodes identified and the presence of extramural vascular invasion or serosal involvement by tumour, have been shown to impact on prognosis 1-2 and particularly to classify a subset of patients with Dukes B disease who have a worse outcome and should therefore be considered for adjuvant therapy.

AIMS & METHODS: To compare performance data between colorectal cancer (CRC) cases trimmed by a pathologist, by our BMS in his extended practice role, RCPath guidelines and other published series. After preliminary review, CRC specimens of appropriate complexity are allocated to the BMS. The Consultant pathologist and the BMS then examine the gross specimen together, discussing block selection and any other areas of concern specific to the case. The Consultant is available for further advice and discussion at any point during trimming. The BMS then reviews the slides of the case plus their performance data in conjunction with the Consultant. Departmental figures are derived from 400 colorectal cases trimmed predominantly by a single Consultant Pathologist, with smaller numbers trimmed by trainee pathologists. The cases trimmed by our BMS are included in this series.

At the time of writing our BMS had trimmed 27 selected cases. These were 1 subtotal colectomy, 13 right hemicolectomies,1 transverse colectomy, 1 left hemicolectomy, 7 sigmoid colectomies and 4 high anterior resections.

RESULTS: BMS cut up performance meets RCPath guidelines and is comparable to overall departmental performance. Of note, our figures fall short of the exceptional results published by Peterson et al 2 in terms of mean lymph node harvest and percentage of cases with serosal involvement.

CONCLUSION: The performance data derived from the selected cases handled by our BMS support the continuation of the BMS extended role within our department, with analysis of further data as it becomes available. The data collected, namely mean lymph node harvest and frequency of extramural vascular invasion and serosal involvement, have been demonstrated to be important in determining patient prognosis and appropriate adjuvant therapy 1,2,4.

REFERENCES: 1. EJA Morris et al. Who to treat with adjuvant therapy in Dukes B/stage II colorectal cancer? The need for high quality pathology. Gut 2007; 56:1419-1425 2. VC Petersen et al. Identification of objective pathological prognostic determinants and models of prognosis in Dukes' B colon cancer. Gut 2002; 51: 65-69 3. RCPath Dataset for colorectal cancer (2nd edition). September 20074. P Quirke, E Morris. Reporting colorectal cancer. Histopathology 2007; 50: 103-112

BMS Departmental RCPath guidelines

Peterson et al

Lymph nodes (mean) 12.7 12.4 12 21.3

Extramural vascular invasion (% of cases) 41 34 25 34

Serosal involvement

(% of cases)22 31 20 41.5