Palga's protocols

The protocals are only available on the Dutch Palga website.

Palga believes that the best treatment begins with the best diagnosis. Every patient in the Netherlands should get the best possible diagnosis. That is why Palga is working hard to optimise pathology diagnoses and reporting. An essential aspect of this is the introduction of standardised synoptic reporting in pathology, using national protocols to collect the same data for every patient in every hospital in the Netherlands, and to present it in a clear and concise manner. This allows for smooth multidisciplinary patient consultations.

National histology protocols

The overview below (only available on Dutch website) shows the latest protocol updates. The most recent updates are displayed in bold. Test reports of CE-marked protocols are available on request.

The documents below provide details on all major changes, as well as on the controls and the screen layout. Click on the links to access the PDFs.

Protocols

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Click here to view a presentation on the use of the Palga Protocol Module. The presentation provides a step-by-step explanation of how two protocols can be linked together under one research number,

using the link between the national Palga protocol for Molecular Determinations and the national Lung Carcinoma protocol as an example.

DTHS has created an import button that allows NGS results to be added to the Molecular Determinations protocol in UDPS. The release notes are available here.
Appendix
- ENETS Consensus Guidelines

Cervix
- Silva system

Colonrectum
- cancers-03-00164_serosal involvement

Colon / Colonbiopt
- Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference

Hoofd hals protocol
- Reproducibility and prognostic value of pattern of invasion scoring in low stage oral squamous cell carcinoma

Hoofd hals biopten
- Digital image analysis of intraepithelial B-lymphocytes to assess lymphoepithelial lesions in salivary glands of Sjögren's syndrome patients
- Increased Diagnostic Accuracy of the Labial Gland Biopsy in Primary Sjögren Syndrome When Multiple Histopathological Features Are Included

Longbiopt
- Diagnosis of Lung Cancer in Small Biopsies and Cytology

Longcytologie
- ROSE screening

MaagOesofaguscarcinoom
- AGA Clinical Practice Update on the Utility of Endoscopic Submucosal Dissection in T1b Esophageal Cancer
- Hereditary diffuse gastric cancer updated clinical guidelines with an emphasis on germline CDH1 mutation carrier

Mammacarcinoom
- Implementation of Targeted Axillary Dissection

Melanoom
- The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care

NET/NEC
- WD-NET vs PD-NEC

Pancreas
- Validation of a Proposed Tumor Regression Grading Scheme for Pancreatic Ductal Adenocarcinoma After Neoadjuvant Therapy as a Prognostic Indicator for Survival
- Prognostic Significance of New AJCC Tumor Stage in Patients With Pancreatic Ductal Adenocarcinoma Treated With Neoadjuvant Therapy

Prostaat
- The 2014 (ISUP) Definition of Grading Patterns and Proposal for a New Grading System
- The 2005 (ISUP) Consensus Gleason Grading of Prostatic Carcinoma

Schildklier
- International Medullary Thyroid Carcinoma Grading System A Validated Grading System for Medullary Thyroid Carcinoma

Urine
- The Paris System

Trial alerts

Currently, one or more trial alerts are operational for the following national protocols

The SAS-trial is a multicentre, prospective cohort study that aims to validate a previously established prediction score for the severity of appendicitis. This score can be used preoperatively to distinguish between patients with simple and complex appendicitis. The study uses data from the standard diagnostic and treatment process.
Lymph node status is an important prognostic parameter in oesophageal carcinoma and an independent predictor of survival. The distribution of metastatic lymph nodes may vary depending on tumour location, histology and invasion depth, and on the use of neoadjuvant therapy. The surgical strategy is informed by the distribution pattern of nodal metastases, but consensus on how much tissue should be removed varies worldwide. For adenocarcinoma, the distribution of lymph node metastases has not yet been described in extensive series reporting on complete two and three-field lymphadenectomies. The lack of homogeneity regarding the classification of lymph node stations makes it difficult to interpret and compare research results. Currently, the only conclusion that can be drawn is that oesophageal cancer often metastasises to the cervical, mediastinal and upper abdominal lymph nodes. The heterogeneity in the available evidence presents a challenge when it comes to finding the most effective surgical strategy, especially given the significant morbidity associated with oesophageal surgery.

An observational study will identify lymph node stations to be resected in relation to tumour characteristics and may clarify whether the optimal surgical strategy for patients receiving neoadjuvant therapy should also be used for patients not receiving this treatment. Moreover, the study will examine the prognostic value of different lymph node stations.

The aim of the current multinational observational cohort study is to evaluate the distribution of lymph node metastases in all patients with resectable (cT1-4a N0-3 M0) oesophageal or gastroesophageal junction carcinoma scheduled for at least a transthoracic two-field lymphadenectomy. This will contribute to the development of a unified global staging system and help determine the optimal surgical strategy for oesophageal cancer patients. In addition, the prognostic value of different lymph node stations, the distribution pattern of recurrences and metastases, the frequency of skip nodal metastases and the ratio between nodal metastases inside and outside the radiation field will be studied.

Read more

Prospective lung study on LC-NEC.

Decentralized guidelines

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The guidelines are set out here.
View the rules for completing sections in UDPS here.
To protect the privacy of patients and those involved in their treatment, the Palga Privacy Committee (PPC) advises the Palga Foundation on the provision of data from Palga’s databases. The amended reporting guidelines for data requests (available here) were adopted in May 2016.

View the rules for completing sections in UDPS here.
The Excel file containing the UDPS dataset is available to suppliers. To request a copy of the file, send an email to stichting@palga.nl.

Lab2lab

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More information on how to use Lab2Lab is available here.
Lab2Lab offers an effective way of requesting consultations, revisions and outsourced testing, such as molecular diagnostics, while guaranteeing patient safety. It allows you to exchange electronic consultation results as well as data from national protocols. As part of the national Palga infrastructure, Lab2Lab will be linked to the Mercury Node and the Mercury Hub.

Technical information about Lab2Lab is available here.

Core UDPS

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UDPS stands for Uniform Decentralised Palga System: a computer system that is placed in clinical pathology labs to facilitate local record keeping. It is also used to send excerpts from pathology reports to Palga’s national database. The functionality of UDPS is intentionally limited to medical records.

All UDPS systems have access to the same national dataset (possibly with some local additions), as indicated by the word ‘uniform’.
More information on how to use Core UDPS is available here.

Some labs that require specific functionality not offered by UDPS may wish to use a third-party pathology system. For these labs, Palga offers Core UDPS: a trimmed-down version of UDPS, which provides a basic interface with Palga’s national database for submitting report excerpts and questions from patients. Third-party systems can communicate with Core UDPS using the standard UDPS XML server. This is described in the document ‘UDPS-XML-publ.doc’.
Technical information about Core UDPS is available here.

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