cancerspЮжно-Российский онкологический журнал/ South Russian Journal of CancerSouth Russian Journal of Cancer2686-9039АНО "Перспективы онкологии"10.37748/2686-9039-2021-2-1-3cancersp-104Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESИспользование электронного архива результатов прижизненных патологоанатомических исследований, как инструмент внутреннего контроля качества кодирования по системе МКБ-О-3 (ICD-O), на примере анализа злокачественных новообразований желудкаUsing the digital archive of pathological reports of stomach cancer as internal quality control of coding according to the ICD-O systemhttps://orcid.org/0000-0003-3061-6108КитО. И.KitO. I.

Кит Олег Иванович – член-корр. РАН, д.м.н., профессор, генеральный директор, SPIN: 1728-0329, AuthorID: 343182, Scopus Author ID: 55994103100, ResearcherID: U-2241-2017.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Oleg I. Kit – member of Russian Academy of Sciences, Dr. Sci. (Med.), professor, general director, SPIN: 1728-0329, ScopusAuthor ID: 55994103100, ResearcherID: U-2241-2017.

63 14 line str., Rostov-on-Don 344037, Russian Federation

ФоменкоЮ. А.FomenkoYu. A.

Фоменко Юрий Александрович – к.м.н., заместитель генерального директора по клинико-экспертной работе, SPIN: 8204-5275, AuthorID: 462430.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Yurii A. Fomenko – Cand. Sci. (Med.), deputy general director for clinical and expert work, SPIN: 8204-5275, AuthorID: 462430.

63 14 line str., Rostov-on-Don 344037, Russian Federation

https://orcid.org/0000-0003-0889-2720КарнауховН. С.KarnaukhovN. S.

Карнаухов Николай Сергеевич – к.м.н., старший научный сотрудник, врач-патологоанатом, SPIN: 3100-0820, AuthorID: 718579, Scopus Author ID: 57193122772.

111123, Российская Федерация, г. Москва, шоссе Энтузиастов, д. 86

Nikolai S. Karnaukhov – Cand. Sci. (Med.), senior researcher, pathologist, SPIN: 3100-0820, AuthorID: 718579, Scopus Author ID: 57193122772.

86 Entuziastov highway, Moscow 111123, Russian Federation

nick07@bk.ruhttps://orcid.org/0000-0002-6544-6113ЛаптеваТ. О.LaptevaT. O.

Лаптева Татьяна Олеговна – заведующая патологоанатомическим отделением, SPIN: 2771-3213, AuthorID: 849370.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Tatyana O. Lapteva – head of the pathology department, SPIN: 2771-3213, AuthorID: 849370.

63 14 line str., Rostov-on-Don 344037, Russian Federation

https://orcid.org/0000-0002-2302-3542ВолошинМ. В.VoloshinM. V.

Волошин Марк Витальевич – врач-ординатор специальности «Патологическая анатомия», SPIN: 6122-4084, AuthorID: 969003, ResearcherID: C-5601-2018.

344022, Российская Федерация, г. Ростов-на-Дону, пер. Нахичеванский, д. 29

Mark V. Voloshin – pathology resident, SPIN: 6122-4084, AuthorID: 969003, ResearcherID: C-5601-2018.

29 Nakhichevansky lane, Rostov-on-Don 344022, Russian Federation

ВакуленкоГ. Ю.VakulenkoG. Yu.

Вакуленко Галина Юрьевна – инженер-техник в патологоанатомическом отделении, SPIN: 4297-8782, AuthorID: 1079754.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Galina Yu. Vakulenko – technical engineer in the pathology department, 4297-8782, AuthorID: 1079754.

63 14 line str., Rostov-on-Don 344037, Russian Federation

БосенкоС. Ж-П.BosenkoS. Zh-P.

Босенко Сергей Жан-Польевич – врач-патологоанатом, SPIN: 1130-6911, AuthorID: 799153.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Sergei Zh-P. Bosenko – pathologist, SPIN: 1130-6911, AuthorID: 799153.

63 14 line str., Rostov-on-Don 344037, Russian Federation

СухарьИ. А.SuharI. A.

Сухарь Ирина Александровна – врач-патологоанатом.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Irina A. Suhar – pathologist.

63 14 line str., Rostov-on-Don 344037, Russian Federation

ЕреминК. С.EreminK. S.

Еремин Константин Станиславович – врач-патологоанатом.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Konstantin S. Eremin – pathologist.

63 14 line str., Rostov-on-Don 344037, Russian Federation

https://orcid.org/0000-0003-4905-4977КаминскийГ. В.KaminskijG. V.

Каминский Геннадий Владимирович – врач-хирург, SPIN: 3308-4107, AuthorID: 794670.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Gennadii V. Kaminskij – surgeon, SPIN: 3308-4107, AuthorID: 794670.

63 14 line str., Rostov-on-Don 344037, Russian Federation

КузнецоваМ. А.KuznecovaM. A.

Кузнецова Марина Александровна – врач-патологоанатом, SPIN: 7647-1737, AuthorID: 1058870.

344037, Российская Федерация, г. Ростов-на-Дону, ул. 14-я линия, д. 63

Marina A. Kuznecova – pathologist, SPIN: 7647-1737, AuthorID: 1058870.

63 14 line str., Rostov-on-Don 344037, Russian Federation

ФГБУ «НМИЦ онкологии» Минздрава РоссииРоссияNational Medical Research Centre for Oncology of the Ministry of Health of RussiaRussian FederationГБУЗ «Московский клинический научный центр им. А.С.Логинова ДЗМ»РоссияMoscow Clinical Research Center named after A.S.LoginovRussian FederationФГБОУ ВО «РостГМУ» Минздрава РоссииРоссияRostov State Medical University Ministry of Health of RussiaRussian Federation202125032021212634Copyright © Кит О.И., Фоменко Ю.А., Карнаухов Н.С., Лаптева Т.О., Волошин М.В., Вакуленко Г.Ю., Босенко С.Ж., Сухарь И.А., Еремин К.С., Каминский Г.В., Кузнецова М.А., 20212021Кит О.И., Фоменко Ю.А., Карнаухов Н.С., Лаптева Т.О., Волошин М.В., Вакуленко Г.Ю., Босенко С.Ж., Сухарь И.А., Еремин К.С., Каминский Г.В., Кузнецова М.А.Kit O.I., Fomenko Y.A., Karnaukhov N.S., Lapteva T.O., Voloshin M.V., Vakulenko G.Y., Bosenko S.Z., Suhar I.A., Eremin K.S., Kaminskij G.V., Kuznecova M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cancersp.com/jour/article/view/104Цель исследования

Цель исследования. Продемонстрировать возможности статистического анализа электронного архива ПАО. Провести внутренний контроль качества кодирования злокачественных опухолей по системе МКБ-О-3 (ICD-O) прижизненных патологоанатомических исследований (ППАИ) на примере ЗНО желудка.

Материалы и методы

Материалы и методы. Нами был ретроспективно произведен экспресс- анализ 368 157 протоколов прижизненных патологоанатомических исследований электронного архива ПАО ФГБУ «НМИЦ онкологии» Минздрава России с 2000 по 2019 год включительно. Для исследования были отобраны 4 857 протоколов прижизненных патологоанатомических исследований пациентов, прооперированных в ФГБУ «НМИЦ онкологии» Минздрава России по поводу злокачественных новообразований желудка (коды МКБ-Х: С16.0 — С16.9), в период с 2000 по 2019 год включительно.

Результаты

Результаты. При анализе 368 157 протоколов электронного архива ПАО было выявлено 4614 злокачественных эпителиальных опухолей желудка, которые распределились следующим образом: аденокарцинома БДУ — 2958, перстневидноклеточный рак — 791, недифференцированный рак — 565, муцинозная аденокарцинома — 210, нейроэндокринные опухоли — 90. Обнаружено значительное увеличение кодов МКБ-О «Аденокарцинома БДУ» РЖ в 2018, 2019 годах. Протоколы ППАИ за эти 2 года были пересмотрены независимым врачом- патологоанатом и внесены изменения в коды МКБ-О согласно классификации ВОЗ опухолей ЖКТ 2019 года. На смену коду АК БДУ (8140/3) пришли коды тубулярной АК (МКБ-О: 8211/3) — 41%, папиллярной АК (8260/3) — 9% и аденокарциномы со смешанными подтипами (8255/3) — 29%.

Заключение

Заключение. В результате проведенного исследования, на примере анализа кодирования МКБ-О ЗНО желудка было продемонстрировано важное значение электронного архива в ПАО, как инструмента быстрого статического анализа ППАИ и контроля качества кодирования. Система кодирования ППАИ может быть основой для проведения крупных многоцентровых исследований в области онкологии. Важно своевременно обновлять коды МКБ-О при выходе новых морфологических классификаций.

Purpose of the study

Purpose of the study. Demonstrate the possibilities of statistical analysis of the digital archive at pathological department (PD). To conduct internal quality control of the coding of malignant tumors according to the ICD-O-3 system of pathology reports using the example of gastric cancer (GC).

Materials and methods

Materials and methods. We retrospectively analyzed the digital archive of 368,157 pathology reports of the National Medical Research Centre for Oncology of the Ministry of Health of Russia from 2000 to 2019. For the study, 4,857 pathology reports of patients operated for gastric malignancies (ICD-X codes: C16.0 – C16.9) were selected for the period from 2000 to 2019.

Results

Results. The analysis of 368,157 protocols of the digital archive of PD revealed 4,614 malignant epithelial tumors of the stomach: tubular adenocarcinoma – 2,958, signet ring cell carcinoma – 791, undifferentiated cancer – 565, mucinous adenocarcinoma – 210, neuroendocrine neoplasia – 90. A significant increase in the ICD-O codes for "adenocarcinoma NOS" was found in 2018 and 2019. The pathology reports for these 2 years were reviewed by an independent pathologist and changes were made to the ICD-O codes according to the WHO classification digestive system tumors 2019. The adenocarcinoma NOS (8140/3) was replaced by the codes: tubular adenocarcinoma (ICD-O: 8211/3) – 41%, papillary adenocarcinoma (8260/3) – 9% and adenocarcinoma with mixed subtypes (8255/3) – 29%.

Conclusion

Conclusion. The study, based on analysis of coding ICD-O stomach MN demonstrated the importance of digital archive at the PD, as a tool for rapid static analysis pathology reports and quality control of coding. The coding system can be the basis for large multicenter studies in oncology. Therefore, it is important to control the quality of coding of the pathology reports and to timely update the codes when new pathological classifications are released.

контроль качестварак желудкаперстневидно-клеточная карциномакарцинома из плохо сцепленных клетоктубулярная аденокарциномадиффузный типкишечный типquality controlstomach cancersignet-cell adenocarcinomapoorly cohesive adenocarcinomatubular adenocarcinomadiffuse typeintestinal typeReferencesOrder of the Ministry of Health of the Russian Federation No. 170 of 27.05.1997 "On the transition of health authorities and institutions of the Russian Federation to the International Statistical Classifi cation of Diseases and Health-related Problems X revision".Order of the Ministry of Health of the Russian Federation No. 170 of 27.05.1997 "On the transition of health authorities and institutions of the Russian Federation to the International Statistical Classifi cation of Diseases and Health-related Problems X revision". (In Russian).Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019 Apr 15;144(8):1941–1953. https://doi.org/10.1002/ijc.31937Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019 Apr 15;144(8):1941–1953. https://doi.org/10.1002/ijc.31937Михалева Л.М., Бирюков А.Е. Морфологические и им- муногистохимические особенности тяжелой дисплазии и раннего рака желудка. Archive of Pathology. 2017;79(4):22–28. https://doi.org/10.17116/patol201779422-28Mikhaleva LM, Biryukov AE. Morphological and immunohistochemical features of severe gastric dysplasia and early gastric cancer. Archive of Pathology. 2017;79(4):22–28. (In Russian). https://doi.org/10.17116/patol201779422-28Hwang SW, Lee DH, Lee SH, Park YS, Hwang JH, Kim JW, et al. Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector-row computed tomography. J Gastroenterol Hepatol. 2010 Mar;25(3):512–518. https://doi.org/10.1111/j.1440-1746.2009.06106.xHwang SW, Lee DH, Lee SH, Park YS, Hwang JH, Kim JW, et al. Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector-row computed tomography. J Gastroenterol Hepatol. 2010 Mar;25(3):512–518. https://doi.org/10.1111/j.1440-1746.2009.06106.xPolkowski W, van Sandick JW, Offerhaus GJ, ten Kate FJ, Mulder J, Obertop H, et al. Prognostic value of Laurén classifi cation and c-erbB-2 oncogene overexpression in adenocarcinoma of the esophagus and gastroesophageal junction. Ann Surg Oncol. 1999 May;6(3):290–297. https://doi.org/10.1007/s10434-999-0290-2Polkowski W, van Sandick JW, Offerhaus GJ, ten Kate FJ, Mulder J, Obertop H, et al. Prognostic value of Laurén classifi cation and c-erbB-2 oncogene overexpression in adenocarcinoma of the esophagus and gastroesophageal junction. Ann Surg Oncol. 1999 May;6(3):290–297. https://doi.org/10.1007/s10434-999-0290-2Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classifi cation. Acta Pathol Microbiol Scand. 1965;64:31–49. https://doi.org/10.1111/apm.1965.64.1.31Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classifi cation. Acta Pathol Microbiol Scand. 1965;64:31–49. https://doi.org/10.1111/apm.1965.64.1.31Caldas C, Carneiro F, Lynch HT, Yokota J, Wiesner GL, Powell SM, et al. Familial gastric cancer: overview and guidelines for management. J Med Genet. 1999 Dec;36(12):873–880.Caldas C, Carneiro F, Lynch HT, Yokota J, Wiesner GL, Powell SM, et al. Familial gastric cancer: overview and guidelines for management. J Med Genet. 1999 Dec;36(12):873–880.Kaneko S, Yoshimura T. Time trend analysis of gastric cancer incidence in Japan by histological types, 1975-1989. Br J Cancer. 2001 Feb 2;84(3):400–405. https://doi.org/10.1054/bjoc.2000.1602Kaneko S, Yoshimura T. Time trend analysis of gastric cancer incidence in Japan by histological types, 1975-1989. Br J Cancer. 2001 Feb 2;84(3):400–405. https://doi.org/10.1054/bjoc.2000.1602Parsonnet J, Vandersteen D, Goates J, Sibley RK, Pritikin J, Chang Y. Helicobacter pylori infection in intestinal- and diffuse- type gastric adenocarcinomas. J Natl Cancer Inst. 1991 May 1;83(9):640–643. https://doi.org/10.1093/jnci/83.9.640Parsonnet J, Vandersteen D, Goates J, Sibley RK, Pritikin J, Chang Y. Helicobacter pylori infection in intestinal- and diffuse- type gastric adenocarcinomas. J Natl Cancer Inst. 1991 May 1;83(9):640–643. https://doi.org/10.1093/jnci/83.9.640Yamashita K, Sakuramoto S, Katada N, Futawatari N, Moriya H, Hirai K, et al. Diffuse type advanced gastric cancer showing dismal prognosis is characterized by deeper invasion and emerging peritoneal cancer cell: the latest comparative study to intestinal advanced gastric cancer. Hepatogastroenterology. 2009 Feb;56(89):276–281.Yamashita K, Sakuramoto S, Katada N, Futawatari N, Moriya H, Hirai K, et al. Diffuse type advanced gastric cancer showing dismal prognosis is characterized by deeper invasion and emerging peritoneal cancer cell: the latest comparative study to intestinal advanced gastric cancer. Hepatogastroenterology. 2009 Feb;56(89):276–281.Zheng H, Takahashi H, Murai Y, Cui Z, Nomoto K, Miwa S, et al. Pathobiological characteristics of intestinal and diffuse-type gastric carcinoma in Japan: an immunostaining study on the tissue microarray. J Clin Pathol. 2007 Mar;60(3):273–277. https://doi.org/10.1136/jcp.2006.038778Zheng H, Takahashi H, Murai Y, Cui Z, Nomoto K, Miwa S, et al. Pathobiological characteristics of intestinal and diffuse-type gastric carcinoma in Japan: an immunostaining study on the tissue microarray. J Clin Pathol. 2007 Mar;60(3):273–277. https://doi.org/10.1136/jcp.2006.038778Данилова Н.В., Олейникова Н.А., Мальков П.Г. Классификация эпителиальных опухолей желудка ВОЗ 2019 г., 5-е издание. Архив патологии. 2020;82(4):58–69. https://doi.org/10.17116/patol20208204158Danilova NV, Oleynikova NA, Malkov PG. 2019 who classifi cation of gastric epithelial tumors, 5th edition. Archive of Pathology. 2020;82(4):58–69. (In Russian). https://doi.org/10.17116/patol20208204158Van der Kaaij RT, Koemans WJ, van Putten M, Snaebjornsson P, Luijten JCHBM, van Dieren JM, et al. A population-based study on intestinal and diffuse type adenocarcinoma of the oesophagus and stomach in the Netherlands between 1989 and 2015. Eur J Cancer. 2020 May;130:23–31. https://doi.org/10.1016/j.ejca.2020.02.017van der Kaaij RT, Koemans WJ, van Putten M, Snaebjornsson P, Luijten JCHBM, van Dieren JM, et al. A population-based study on intestinal and diffuse type adenocarcinoma of the oesophagus and stomach in the Netherlands between 1989 and 2015. Eur J Cancer. 2020 May;130:23–31. https://doi.org/10.1016/j.ejca.2020.02.017Luu C, Thapa R, Woo K, Coppola D, Almhanna K, Pimiento JM, et al. Does histology really infl uence gastric cancer prognosis? J Gastrointest Oncol. 2017 Dec;8(6):1026–1036. https://doi.org/10.21037/jgo.2017.09.08Luu C, Thapa R, Woo K, Coppola D, Almhanna K, Pimiento JM, et al. Does histology really infl uence gastric cancer prognosis? J Gastrointest Oncol. 2017 Dec;8(6):1026–1036. https://doi.org/10.21037/jgo.2017.09.08Crisan A, Badulescu F, Badulescu A, Simionescu C, Andrei I, Cimpeanu R. Clinical, Histological and Prognosis Correlations in Diagnosis and Treatment of Gastric Cancer. Curr Health Sci J. 2016 Sep;42(3):238–256. https://doi.org/10.12865/CHSJ.42.03.04Crisan A, Badulescu F, Badulescu A, Simionescu C, Andrei I, Cimpeanu R. Clinical, Histological and Prognosis Correlations in Diagnosis and Treatment of Gastric Cancer. Curr Health Sci J. 2016 Sep;42(3):238–256. https://doi.org/10.12865/CHSJ.42.03.04Неред С.Н., Клименков А.А., Перевощиков А.Г. Клинико-морфологические особенности перстне видноклеточного рака желудка. Вестник РОНЦ им. Н.Н.Блохина РАМН. 2004;15(3):37–42.Nered SN, Klimenkov AA, Perevostchikov AG. Clinicomorphological features of signet-ring cell carcinoma of the stomach. Bulletin of the N.N.Blokhin Russian Research Center of the Russian Academy of Medical Sciences. 2004;15(3):37–42. (In Russian).Stiekema J, Cats A, Kuijpers A, van Coevorden F, Boot H, Jansen EPM, et al. Surgical treatment results of intestinal and diffuse type gastric cancer. Implications for a differentiated therapeutic approach? Eur J Surg Oncol. 2013 Jul;39(7):686–693. https://doi.org/10.1016/j.ejso.2013.02.026Stiekema J, Cats A, Kuijpers A, van Coevorden F, Boot H, Jansen EPM, et al. Surgical treatment results of intestinal and diffuse type gastric cancer. Implications for a differentiated therapeutic approach? Eur J Surg Oncol. 2013 Jul;39(7):686–693. https://doi.org/10.1016/j.ejso.2013.02.026de Aguiar VG, Segatelli V, Macedo AL de V, Goldenberg A, Gansl RC, Maluf FC, et al. Signet ring cell component, not the Lauren subtype, predicts poor survival: an analysis of 198 cases of gastric cancer. Future Oncol. 2019 Feb;15(4):401–408. https://doi.org/10.2217/fon-2018-0354de Aguiar VG, Segatelli V, Macedo AL de V, Goldenberg A, Gansl RC, Maluf FC, et al. Signet ring cell component, not the Lauren subtype, predicts poor survival: an analysis of 198 cases of gastric cancer. Future Oncol. 2019 Feb;15(4):401–408. https://doi.org/10.2217/fon-2018-0354Liu X, Cai H, Sheng W, Yu L, Long Z, Shi Y, et al. Clinicopathological Characteristics and Survival Outcomes of Primary Signet Ring Cell Carcinoma in the Stomach: Retrospective Analysis of Single Center Database. PLoS One. 2015;10(12):e0144420. https://doi.org/10.1371/journal.pone.0144420Liu X, Cai H, Sheng W, Yu L, Long Z, Shi Y, et al. Clinicopathological Characteristics and Survival Outcomes of Primary Signet Ring Cell Carcinoma in the Stomach: Retrospective Analysis of Single Center Database. PLoS One. 2015;10(12):e0144420. https://doi.org/10.1371/journal.pone.0144420Piessen G, Messager M, Leteurtre E, Jean-Pierre T, Mariette C. Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoral clinical presentation. Ann Surg. 2009 Dec;250(6):878–887. https://doi.org/10.1097/SLA.0b013e3181b21c7bPiessen G, Messager M, Leteurtre E, Jean-Pierre T, Mariette C. Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoral clinical presentation. Ann Surg. 2009 Dec;250(6):878–887. https://doi.org/10.1097/SLA.0b013e3181b21c7bJapanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021 Jan;24(1):1–21. https://doi.org/10.1007/s10120-020-01042-yJapanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021 Jan;24(1):1–21. https://doi.org/10.1007/s10120-020-01042-yLauren P. The two histological main types of gastric carcinoma. An attempt at a histo-clinical classifi cation. Acta Pathol Microbiol Scand. 1965;64:31–49. https://doi.org/10.1111/apm.1965.64.1.31Lauren P. The two histological main types of gastric carcinoma. An attempt at a histo-clinical classifi cation. Acta Pathol Microbiol Scand. 1965;64:31–49. https://doi.org/10.1111/apm.1965.64.1.31Nakamura K, Sugano H, Takagi K. Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances. Gan. 1968 Jun;59(3):251–258.Nakamura K, Sugano H, Takagi K. Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances. Gan. 1968 Jun;59(3):251–258.Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classifi cation of tumours of the digestive system. Histopathology. 2020 Jan;76(2):182–188. https://doi.org/10.1111/his.13975Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classifi cation of tumours of the digestive system. Histopathology. 2020 Jan;76(2):182–188. https://doi.org/10.1111/his.13975

The authors declare that there are no conflicts of interest present.