In Reply.—We thank the authors of this letter for bringing to our attention their well-considered paper, which became available in press after we had completed our study and drafted our manuscript. Although our studies differ in design (for instance, we assessed interpathologist variability using real-case synoptic data in addition to a survey-based approach, we assessed lymphovascular invasion reporting in addition to the reporting of pT3 versus pT4a stage, and our synoptic data elements were based on the College of American Pathologists Cancer Protocol Template1  rather than the Dutch Pathology Registry), our studies both demonstrate the existence of considerable variability in pT4a staging. We agree entirely that widely accepted, standardized diagnostic criteria for pT3 versus pT4a staging are needed and appreciate the value of the aforementioned study in highlighting this need.

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Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum
College of American Pathologists

Yang and Schaeffer contributed equally to this work.

The authors have no relevant financial interest in the products or companies described in this article.