Special Working Party Interview with Charles H. Knowles and Roberto de Giorgio
GASTRO 2009 Working Party “Guidelines on histological techniques and reporting: The London Classification of GI neuromuscular pathology”
1. When did your working party " Guidelines on histological techniques and reporting: The London Classification of GI neuromuscular pathology " start its work and tell us a little bit about why you wanted to be involved in this working party?
The idea originated from informal discussions at the Festschrift for Prof. Peter Milla at the Inst. of Child Health, London in March 2006. Prof. Milla and other colleagues had long wished to try and rationalise the practice of GI neuromuscular histological reporting and disease classification. We agreed to try and push this process forward after his retirement. After a failure to formalise this process by other means, we applied for selection as a Gastro 2009 Working Party. Work started in earnest in July 2007 with the recruitment of other members.
The subject area was one that all members recognised as having an urgent need for standardization. From our own perspective, both of us are often faced with the dilemma of giving opinions on the results of histology to patients without a firm international consensus of their validity and interpretation. The implications of this to the patient are not inconsequential.
2. Have the guidelines produced by your Working Party already been classified or published?
The detailed guidelines have been published in the August edition of Acta Neuropathologica. This ‘opus’ spans 31 pages of the paper journal, has 172 accompanying references, numerous figures and tables as well as several key sets of reporting and referral recommendations to guide the general pathologist. Supplemental material is provided digitally. The full reference is:
Knowles CH, De Giorgio R, Kapur RP, Bruder E, Farrugia G, Geboes K, Gershon MD, Hutson J, Lindberg G, Martin JE, Meier-Ruge WA, Milla PJ, Smith VV, Vandervinden JM, Veress B, Wedel T. Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. Acta Neuropathol 2009;118:271-301.
Free reprints of this article will be available at the Working Party Meeting on November 23, 2009.
3. Will you develop a classification, and if so, does it have global applicability?
We are in the process of developing a contemporary classification of gastrointestinal neuromuscular pathology based on defined histopathological criteria and using the guidelines as a platform. In recognition of its origins and first presentation in London at the World Congress of Gastroenterology 2009, GASTRO 2009, this has been named ‘The London Classification’. The classification should necessarily be viewed as a starting point for future modification as new data become available. It will have global applicability. We anticipate publication of this classification later this year in a major general gastroenterology journal.
4. How do the working parties help to improve patient care?
In respect of our working party, we believe that the process facilitated by the WGO will have significant benefits for patient care. The immediate implementation of the guidelines and classification should allow diagnostic standardization, and provide useful prognostic and therapeutic information. As the classification develops further, it is envisaged that it will provide a firmer base for longer term collaborative studies with the development of databases that aim to lead to a better understanding of underlying disease mechanisms, developments in diagnostic biomarkers and perhaps more effective (directed / targeted) therapies.
5. What is the next step for your Working Party?
The classification offers a provisional ‘snapshot in time’ which utilises best available current evidence and coalescence of expert opinion. Of particularly relevance to future modification is the delineation of quantitative normative data for GINMP that are age, gender and region specific. The Working Party identified this as the area of critical need for future research since the histopathological phenotypes defined by the guidelines were deliberately highly conservative based on the absence of adequate data to provide quantitative limits of normality in the individual. The Working Party has nevertheless suggested standards that might result in the establishment of normal values that would be applicable across centres and which are a future aim of a developing international cooperative study group.
We would also like to thank all members of the working party for all their hard work.
Charles H Knowles and Roberto de Giorgio (Chairs)
Learn more about the outcomes of this Working Party at GASTRO 2009.
Working Party Report: Guidelines on histological techniques and reporting: The London Classification of GI neuromuscular pathology
Date: Monday, November 23, 2009
Time: 11:00 - 12:30
Venue: Platinum 3/4.
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