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Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles.

导管内乳头状粘液性肿瘤各亚型的观察者差异和粘蛋白免疫分析的应用

Kwak HA,Liu X,Allende DS,Pai RK,Hart J,Xiao SY

Abstract

Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ=0.41, P<0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ=0.56, P<0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ=0.43, P<0.01; κ=0.38, P<0.01; κ=0.17, P<0.01; κ=0.08, P<0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes.

摘要

导管内乳头状粘液性肿瘤被认为是胰腺腺癌的前驱病变。该病变可进一步分为四个组织学亚型:胃型、肠型,胰胆管型和嗜酸细胞亚

本研究的第一目的是评估导管内乳头状粘液性肿瘤亚型的诊断在5名胃肠道病理病理学家之间的观察者差异,第二个目的是比较具有亚型诊断一致性(≥80%)的导管内乳头状粘液性肿瘤各型黏液的免疫组化特征(MUC1、MUC2、MUC5AC、MUC6和CDX2)。58%病例(29/50)的组织学分型在5名肠胃病理学家得到一致的诊断。

总体来讲,在不应用免疫组织化学的情况下,导管内乳头状粘液性肿瘤的诊断分型具有中度一致性(κ= 0.41,P < 0.01)。各观察者之间一致性最高的组织学亚型是肠型(κ= 0.56,P < 0.01),其次是胰胆管型、胃型、混合型和嗜酸细胞型(分别为κ= 0.43,P < 0.01;κ= 0.38,P < 0.01;κ= 0.17,P < 0.01;κ= 0.08,P < 0.04)。混合型和嗜酸细胞型在这项研究中的病例较少,这两个亚型的κ值可能是人为的降低,而不是观察者一致性偏低的一个真正表现。

随后经过两个胃肠病理学家之间的部门共识会议,导管内乳头状粘液性肿瘤病例亚型诊断的一致性达到了68%(34/50)。而诊断不一致的亚型中,有69%(11/16)可以根据各自粘液的免疫组化特性进行分型。粘蛋白免疫组织化学套餐(MUC1、MUC2、MUC5AC和 MUC6)的标准化应用可提高导管内乳头状粘液性肿瘤组织学亚型的诊断一致性。

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