E-learning for instruction of scoring the tumour-stroma ratio (TSR) in colon carcinoma amongst international pathologists, as part of the UNITED study Marloes Smit, PhD-student ALL AUTHORS DECLARE NO CONFLICT OF INTEREST
Background The tumour-stroma ratio (TSR) parameter is based on the amount of stroma within the primary tumour. A high stroma percentage predicts for worse disease outcome . The TSR can be determined at routine pathology . The TSR is validated in various (international) studies. 2 UNITED study – www.watchstroma.com 15-Oct-19
Tumour-stroma ratio Stroma-low tumour Stroma-high tumour 3 UNITED study – www.watchstroma.com 15-Oct-19
Survival 5-years OS 5-years DFS Stroma-low: 78% Stroma-low: 69% Stroma-high: 18% Stroma-high: 12% 4 UNITED study – www.watchstroma.com 15-Oct-19
Scoring TSR View with a 2.5x or 5x objective and find the part with the most stroma visible 5 UNITED study – www.watchstroma.com 15-Oct-19
Scoring TSR Zoom in and view that area with a 10x objective. 6 UNITED study – www.watchstroma.com 15-Oct-19
Scoring TSR A scoring area should contain: - Tumour cells on four sides - As much as stroma possible - No muscle or necrosis Estimate the percentage for the amount of stroma, in increments of 10%. 7 UNITED study – www.watchstroma.com 15-Oct-19
Methods (1) The UNITED study → Uniform Noting for International application of the Tumour-stroma ratio as Easy Diagnostic tool The study is designed to prepare implementation of the TSR in routine diagnostic pathology 8 UNITED study – www.watchstroma.com 15-Oct-19
Methods (2) The UNITED study consists of 4 elements: a. Training national and international pathologists using an E-learning b. Validation in large prospective cohort in international setting c. Automation of the TSR d. Prepare implementation for shared decision making 9 UNITED study – www.watchstroma.com 15-Oct-19
Results (1) 10 UNITED study – www.watchstroma.com 15-Oct-19
Results (2) Training set No. of participants finished 36 Median kappa value 0.72 Minimum kappa value 0.21 Maximum kappa value 0.90 11 UNITED study – www.watchstroma.com 15-Oct-19
Results (3) Test set No. of participants finished 34 Median kappa value 0.77 Minimum kappa value 0.51 Maximum kappa value 0.97 12 UNITED study – www.watchstroma.com 15-Oct-19
Results (4) Repetition set No. of participants finished 31 Median kappa value 0.76 Minimum kappa value 0.60 Maximum kappa value 0.89 13 UNITED study – www.watchstroma.com 15-Oct-19
Results (5) Intra-observer No. of participants finished 31 Median kappa value 0.77 Minimum kappa value 0.61 Maximum kappa value 0.95 14 UNITED study – www.watchstroma.com 15-Oct-19
Results (6) Significant improvement from training to test set: p=0.002 No change from test to repetition test set: p=0.299 15 UNITED study – www.watchstroma.com 15-Oct-19
Conclusion TSR can be scored during diagnostics in 1-2 minutes on H&E stained sections ~ 70% passed the training set only by auto-instruction ~ 90% passed the test set by training No relapse after 2 months wash-out period E-learning is an effective method to instruct pathologists and pathology trainees for scoring TSR, confirming the reproducibility of the TSR scoring method. 16 UNITED study – www.watchstroma.com 15-Oct-19
Collaborations and funding Participating pathologists and residents Other collaborations - European Society of Pathology (ESP) - Els Dequeker, Leuven University, EQA - Jeroen vd Laak, Radboud University Medical Center Department of Surgery LUMC - Marloes Smit - Gabi van Pelt - Wilma Mesker Contact information Datacenter LUMC - Rob Tollenaar - Annet Roodvoets Email: UNITED@lumc.nl - Elma van Meershoek Website: www.watchstroma.com 17 UNITED study – www.watchstroma.com 15-Oct-19
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