Browsing by Author "Siriwardana, P.N."

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Accuracy of histopathology reporting in colorectalcancer (crc): we need a proforma
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Siriwardana, P.N.; Rathnayaka, G.; Deen, K.I.
INTRODUCTION: The quality of a histopathology report in CRC will determine prognosis and the need for adjuvant therapy. OBJECTIVE: To evaluate the completeness of pathology reports in colorectal cancer.METHODS: In 82 consecutive patients (rectal cancer 47, colon cancer 35) based on the minimum data set by the Royal College of Pathologists, UK. Pathology reports were reviewed by a single person who looked for 17 pathology data sets for colon cancer and 15 for rectal cancer. Completeness of reporting(%) was classified as 40 - 50%, 60 - 70% or 80 - I 00%. RESULTS: 47 of rectal cancer group, 5 (11%) reports were 40-59% complete and 23 (49%) and 19 (40%) were 60-79% and 80-100% complete respectively. In the colon cancer group 04 ( 11.5%), 13.(37%) and 18 (51.5%) were in the categories of 40-59%, 60-79% and 80-100% respectively. The presence or absence of tumour at the resection margin was reported in 91.5%. Information on the distance of tumour to distal resection margin was present in 68% of reports. Apical node involvement was commented in 33%. CONCLUSION: There is a wide variation in the quality of pathology reports in colorectal cancer. We have found a lack of vital data in up to two thirds of the reports.
A Case of primary squamous carcinoma of breast
(Sri Lanka Medical Association, 2005) Siriwardana, P.N.; Fernando, R.
No Abstract Available
Colonoscopic ultrasound is associated with a learning phenomenon despite previous rigid probe experience
(Springer India, 2009) Siriwardana, P.N.; Hewavisenthi, S.J.de S.; Pathmeswaran, A.; Deen, K.I.
Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve. We evaluated the predictability CUS in preoperative staging of rectal cancer during the learning curve, despite experience with TRUS. Forty-four patients with non-obstructing rectal cancer were assessed by colonoscopy and colonic ultrasound using a 7.5 MHz rotating transducer. Accuracy of ultrasound staging was compared with pathological staging. Tumor staging and nodal staging at pathology and ultrasound were named pT, pN and uT, uN, respectively. The pathological staging was pT1 in two (4.5%), pT2 in 16 (36%), pT3 in 21 (48%) and pT4 in five (11.5%) rectal cancer specimens. CUS understaged the tumor in 11 cases and overstaged it in 10 cases. Overall, the positive predictive value was 61%, negative predictive value 73%, sensitivity 61%, and specificity 73%. Lymph nodes were not visualized in 14. The overall un-weighted kappa of CUS staging of RC was 0.18 (poor). The predictive value in tumor staging of CUS is suboptimal in the learning phase, despite previous experience with TRUS.
Histopathology reporting in colorectal cancer
(Sri Lanka Medical Association, 2006) Siriwardana, P.N.; Hewavisenthi, S.J.de S.; Deen, K.I.
No Abstract Available.
Histopathology reporting in colorectal cancer: a proforma improves quality
(Wiely-Blackwell, 2009) Siriwardana, P.N.; Pathmeswaran, A.; Hewavisenthi, J.; Deen, K.I.
AIM: The histopathology report is vital to determine the need for adjuvant therapy and prognosis in colorectal cancer (CRC). Completeness of those in text format is inadequate. This study evaluated the improvement of quality of histopathology reports following the introduction of a template proforma, based on standards set by the Royal College of Pathologists (RCP), UK. METHOD: Sixty-eight consecutive histopathology reports based on 19 items for rectal cancer (RC) and 15 items for colon cancer (CC) using the proforma were prospectively analysed and compared with results of a previous audit of 82 consecutive histopathology reports in text format. The percentage of reports containing a statement for each data item for both series was compared using the Normal test for difference between two proportions. Completeness of each report was assessed and a percentage score (percentage completeness) was given. Mean percentage completeness was calculated for each format and compared using the two sample t-test. RESULTS: Except for comments on the presence of 'histologically confirmed liver metastases' in CC and RC, 'distance from dentate line' and 'distance to circumferential margin' in RC, all other items were commented in more than 90% of reports, where 71% of the items based on the minimum data set were present in all reports. Compared to prose format, the mean percentage completeness (SD) improved from 74% (8) to 91% (4) (P < 0.0001) and from 81% (5) to 99% (1) (P < 0.0001) for RC and CC respectively in template proforma format. CONCLUSION: A template proforma and surgeon's contribution in relation to operative findings improves the quality of the histopathology report in CRC.
Natural course of acquired undescended testis in boys
(Wiley, 2003) Siriwardana, P.N.; Satheeshan, B.; Ariyaratne, M.H.J.; Deen, K.I.
Comment On Br J Surg 2003; 90: 728-731. No Abstract Available
Natural course of undescended testis in boys
(2003) Siriwardana, P.N.; Satheeshan, B.; Ariyaratne, M.H.J.; Deen, K.I.
No Abstract available
Total thyroidectomy in benign disease of the thyroid
(Sri Lanka Medical Association, 2005) Siriwardana, P.N.; Fernando, R.
INTRODUCTION: Total thyroidectomy (TT) is a new concept in management of benign diseases of the thyroid (BDT). Many surgeons are reluctant to perform TT for BDT due to the presumed risk of recurrent laryngeal nerve (RLN) damage and hypo parathyroid ism. Subtotal thyroidectomy is associated with a higher rate of recurrence and surgery for recurrent goiter has a significantly high rate of RLN damage and hypoparathyroidisrn. The current world trend favours TT for BDT. However, there is very little data on TT for BDT in Sri Lanka. PATIENTS AND METHODS: Epidemiological data, data on thyroid illness and postoperative complications of 22 consecutive patients who underwent TT for BDT between May 2001 and Aug 2004 were recorded in a standardized proforma. RESULTS: The median age was 46.5 (range 27 - 64) years. There were 20 females and 2 males. Nine patients had toxic nodular goiters, 9 had euthyroid nodular goiters while 4 had diffuse toxic goiters. Postoperative vocal cord examination which was performed during extubation, revealed normal vocal cord function in all patients. However 8 (36.5%) patients complained of transient hoarseness of voice and 3 (13.5%) patients developed transient hypoparathyroidisrn. All these symptoms resolved within 2 months of surgery. There were no recurrences duringa mean follow-up of 15.2 months. One patient's histology revealed an incidental folltcular carcinoma. CONCLUSIONS: TT thyroidectomy is safe with a low incidence of complications. It has several advantages including dealing with occult malignancies and preventing recurrence.