Laboratory variation in the grading of dysplasia of duodenal adenomas in familial adenomatous polyposis patients.
Publication year
2023Source
Familial Cancer, 22, 2, (2023), pp. 177-186ISSN
Annotation
01 april 2023
Publication type
Article / Letter to editor
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Organization
Gastroenterology
Pathology
Neurosurgery
Surgery
IQ Healthcare
Journal title
Familial Cancer
Volume
vol. 22
Issue
iss. 2
Page start
p. 177
Page end
p. 186
Subject
Radboudumc 14: Tumours of the digestive tract Gastroenterology; Radboudumc 14: Tumours of the digestive tract Pathology; Radboudumc 18: Healthcare improvement science IQ Healthcare; Radboudumc 18: Healthcare improvement science Neurosurgery; Radboudumc 18: Healthcare improvement science Surgery; Radboud University Medical CenterAbstract
To prevent duodenal and ampullary cancer in familial adenomatous polyposis (FAP) patients, a diagnosis of high grade dysplasia (HGD) plays an important role in the clinical management. Previous research showed that FAP patients are both over- and undertreated after a misdiagnosis of HGD, indicating unwarranted variation. We aimed to investigate the laboratory variation in dysplasia grading of duodenal adenomas and explore possible explanations for this variation. We included data from all Dutch pathology laboratories between 1991 and 2020 by retrieving histology reports from upper endoscopy specimens of FAP patients from the Dutch nationwide pathology databank (PALGA). Laboratory variation was investigated by comparing standardized proportions of HGD. To describe the degree of variation between the laboratories a factor score was calculated. A funnel plot was used to identify outliers. A total of 3050 specimens from 25 laboratories were included in the final analyses. The mean observed HGD proportion was 9.4%. The top three HGD-diagnosing laboratories diagnosed HGD 3.9 times more often than the lowest three laboratories, even after correcting for case-mix. No outliers were identified. Moderate laboratory variation was found in HGD diagnoses of duodenal tissue of FAP patients after adjusting for case-mix. Despite the fact that no outliers were observed, there may well be room for quality improvement. Concentration of these patients in expertise centers may decrease variation. To further reduce unwarranted variation, we recommend (inter)national guidelines to become more uniform in their recommendations regarding duodenal tissue sampling and consequences of HGD diagnoses.
This item appears in the following Collection(s)
- Academic publications [246646]
- Electronic publications [134197]
- Faculty of Medical Sciences [93384]
- Open Access publications [107722]
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