Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma.

子宫高级别宫内膜样腺癌诊断中的观察者（诊断者）间变异性

Thomas S,Hussein Y,Bandyopadhyay S,Cote M,Hassan O,Abdulfatah E,Alosh B,Guan H,Soslow RA,Ali-Fehmi R

阅读：1057 Archives of Pathology & Laboratory Medicine； Volume 140, Issue 8 (August 2016):836-43

Abstract

-Low interobserver diagnostic agreement exists among high-grade endometrial carcinomas.
-To evaluate diagnostic variability in International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid adenocarcinoma (G3EC) in 2 different sign-out practices.
-Sixty-six G3EC cases were identified from pathology archives of Wayne State University (WSU, Detroit, Michigan) (general surgical pathology sign-out) and 65 from Memorial Sloan Kettering Cancer Center (MSK, New York, New York) (gynecologic pathology focused sign-out). Each case was reviewed together by 2 gynecologic pathologists, one from each institution, and classified into the G3EC group or a reclassified group. Clinicopathologic parameters were compared.
-Twenty-five WSU cases (38%) were reclassified as undifferentiated (n = 2), serous (n = 4), mixed endometrioid and serous carcinomas (n = 12), and FIGO grade 2 endometrioid adenocarcinomas with focal marked nuclear atypia (n = 7). Eleven MSK cases (17%) were reclassified as undifferentiated (n = 5), serous (n = 1), mixed endometrioid and serous carcinomas (n = 4), and mixed endometrioid and clear cell carcinomas (n = 1). Agreement rate between original and review diagnosis was 83% (54 of 65) at MSK and 62% (41 of 66) at WSU (P = .01) with an overall rate of 73% (95 of 131). There were more undifferentiated carcinomas at MSK than there were at WSU (45% [5 of 11] versus 8% [2 of 25]; P = .02). There were more grade 2 endometrioid adenocarcinomas with focal, marked nuclear atypia at WSU (28%; 7 of 25) than there were at MSK (0%) (P = .03). Mixed endometrioid and serous carcinoma was the most common misclassified subtype (44%; 16 of 36).
-Moderate interobserver variability exists in the diagnosis of G3EC with a significantly greater diagnostic agreement rate in gynecologic pathology-focused sign-out than in general sign-out practice.

摘要

子宫内膜高级别腺癌中观察者（诊断者）间的诊断一致性较低。

本研究对两个不同病理团队诊断的国际妇产科联盟（FIGO）3级宫内膜样腺癌（G3EC）病例进行了诊断变异性评估。

研究中所采用FIGO3级宫内膜样腺癌（G3EC）病例来自两所不同机构的病理档案，66例来自韦恩州立大学（WSU，底特律，密歇根），其工作范围是大外科（综合性）病理，65例来自纪念斯隆-凯特琳癌症中心（MSK，纽约，纽约州），其工作范围重点是妇科病理学。研究中每个病例均接受2位妇科病理学家一起再阅片，这两位病理学家分别来自这两所机构，这些病例被分类为G3EC组或再分类组，并对这些病例的临床病理指标也进行了比较。25例（38%）来自WSK的病例被重新分为其他类型，具体如下：未分化癌（2例），浆液性腺癌（4例），混合性宫内膜样腺癌和浆液性腺癌（12例），以及具有灶性显著核异型的FIGO 2级宫内膜样腺癌（7例）。11例（17%）来自MSK的病例被重新分为其他类型，具体如下：未分化癌（5例），浆液性腺癌（1例），混合性宫内膜样腺癌和浆液性腺癌（4例），以及混合性宫内膜样腺癌和透明细胞腺癌（1例）。原始诊断和再阅片的诊断一致率在两所机构分别是83% (54 / 65，MSK)和62% (41 / 66，WSU)，P = .01，总的一致率是73% (95 / 131)。未分化癌病例数量在MSK比WSU更多，分别是45%（5/11）和8%（2/25），P = .02。有灶性显著核异型的FIGO 2级宫内膜样腺癌的病例数量WSU比MSK多，分别是28%（7/25）和0%，P = .03。最常见被错误分类的亚型是混合性宫内膜样腺癌和浆液性腺癌（44%，16/36）。