The edition · Pathology
WHO grading triples high-grade colorectal cancer calls, and why genomic panels fail
Five GI pathologists called about three times as many colorectal cancers high grade under WHO criteria as under AJCC, the sixth WHO soft tissue and bone volume adds 19 entities, and tumour content explained most failed comprehensive genomic profiles.
The edition in brief
Today's pathology edition. Five gastrointestinal pathologists grading 100 colorectal cancers agreed about as well under WHO 6th edition criteria as under the two-tier AJCC scheme (kappa 0.73 for both), but called on average 34 tumours high grade by WHO criteria against 12 by AJCC, a difference that may change who is offered adjuvant treatment. The sixth edition WHO classification of soft tissue and bone tumours adds 19 new entities, refines essential and desirable criteria for different resource settings, and replaces the term variant with morphological pattern. In 371 consecutive requests for a comprehensive genomic panel at a Japanese centre, 14% were cancelled before submission and low tumour content was the only independent predictor of a qualified rather than full result; in qualified reports, tumour mutational burden and MSI were often unassessable. An H&E-based deep-learning score for resected pancreatic cancer added modest prognostic information across seven cohorts, though its fixed cut-off failed to transfer to one. The pearl covers checking tumour content before sending a block for sequencing.
The sixth WHO soft tissue and bone volume adds 19 entities and retires 'variant'
Plan the switch to the sixth edition WHO soft tissue and bone classification now, starting with templates, terminology and molecular send-out pathways.
Low tumour content caused most failed comprehensive genomic profiles
Check tumour content and choose the block before genomic profiling; low content was the main cause of failed or limited reports.
An H&E-derived score refined pancreatic cancer prognosis, but its cut-off did not travel
H&E-based AI scores may add prognostic detail in pancreatic cancer, but are not ready for reporting and need local recalibration.
Circle the tumour before the block goes for sequencing
A marked slide and an honest tumour-nuclei estimate are the cheapest quality control in molecular pathology.
WHO criteria called three times as many colorectal cancers high grade as AJCC
Name the grading scheme on every colorectal cancer report; WHO criteria called about three times as many tumours high grade as AJCC.
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