Assessment of Interobserver Variability and Histologic Parameters to Improve Reliability in Classification and Grading of Central Cartilaginous Tumors
Assessment of Interobserver Variability and Histologic Parameters to Improve Reliability in Classification and Grading of Central Cartilaginous Tumors
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DOI：
10.1097/pas.0b013e31817eec2b
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发表时间：
2009-01-01
影响因子：
5.6
通讯作者：
Hogendoorn, Pancras C. W.
中科院分区：
文献类型：
--
作者：
Eefting, Daniel;Schrage, Yvonne M.;Hogendoorn, Pancras C. W.
良恶性骨软骨肿瘤的鉴别是外科病理学中最困难的课题之一。软骨肉瘤的分级在病理学家之间似乎也有很大差异。然而，临床管理不同。本研究的目的是（1）研究观察者之间在中央软骨肿瘤的组织学诊断和分级方面的差异性;（2）评估定义的组织学参数在区分内生软骨瘤和中央I级软骨肉瘤中的诊断价值。使用IS专业病理学家评价的一组16例病例评估观察者间变异性。随后，收集了20例内生软骨瘤和37例中央I级软骨肉瘤，这些软骨肉瘤是在一个多学科小组中诊断的，具有完整的临床、放射学和病理学数据，并进行了10年的随访。评估细胞学和组织结构特征，以找到区分内生软骨瘤和中央I级软骨肉瘤的最佳参数。我们证明软骨肿瘤的组织学评估有相当大的差异（加权kappa = 0.78）。内生软骨瘤和I级软骨肉瘤之间的区别被证明是最不一致的（kappa系数= 0.54），并且I级和II级软骨肉瘤之间的区别也受到变异的影响（kappa系数= 0.80）。应用5个参数（高细胞性、宿主骨包埋、开放染色质、粘液基质质量和45岁以上）的组合，可以最佳区分内生软骨瘤和中央I级软骨肉瘤。基于2个参数（粘液基质变性超过20%和/或存在宿主骨卡压）的分类树，57例病例中的54例（94.7%）被正确评估（灵敏度95%，特异性95%）。我们的研究证实了中央性软骨肉瘤的诊断和分级的可靠性低。然而，这些分类指导日常实践中的治疗决策。因此，我们提出了一种分类模型，结合量身定制的放射学评估，可以提高软骨肿瘤诊断的可靠性。
The distinction between benign and malignant cartilaginous tumors of bone is one of the most difficult subjects in surgical pathology. The grading of chondrosarcoma also seems to vary considerably among pathologists. However, clinical management differs. The purpose Of this Study was (1) to investigate interobserver variability in histological diagnosis and grading of central cartilaginous tumors and (2) to assess the diagnostic value of defined histologic parameters in differentiating enchondroma and central grade I chondrosarcoma. The interobserver variability was assessed using a set of 16 cases evaluated by IS specialized pathologists. Subsequently, 20 enchondromas and 37 central grade I chondrosarcomas diagnosed in a multidisciplinary team with full clinical, radiologic, and pathologic data available with 10 years of follow-up were collected. Cytologic and tissue-architectural features were assessed to find an optimal set of parameters to differentiate enchondroma from central grade I chondrosarcoma. We demonstrate considerable variation in the histologic assessment of cartilaginous tumors (weighted kappa = 0.78). The distinction between enchondroma and grade I chondrosarcoma was shown to be the most disconcordant (kappa coefficient = 0.54) and also the differentiation between grade I and grade II chondrosarcoma was Subjected to variation (kappa coefficient = 0.80). The application of a combination of 5 parameters (high cellularity, presence of host bone entrapment, open chromatin, mucoid matrix quality, and age above 45 ) allowed optimal differentiation between enchondromas and central grade I chondrosarcomas. With a classification tree based on 2 parameters (mucoid matrix degeneration more than 20% and/or host bone entrapment present), 54 of the 57 (94.7%) cases were assessed correctly (sensitivity 95% and specificity 95%). Our study confirms the low reliability of the diagnosis and grading of central chondrosarcoma. However, these classifications guide therapeutic decision making in daily practice. Therefore, we propose a classification model that, combined with a tailored radiologic assessment, may improve reliability of the diagnosis of cartilaginous tumors.