Diagnosis of serous tubal intraepithelial carcinoma based on morphologic and immunohistochemical features: a reproducibility study.
Diagnosis of serous tubal intraepithelial carcinoma based on morphologic and immunohistochemical features: a reproducibility study.
复制标题
DOI：
10.1097/pas.0b013e31822f58bc
复制
发表时间：
2011-12
期刊：
影响因子：
--
通讯作者：
Kurman RJ
中科院分区：
文献类型：
--
作者：
Visvanathan K;Vang R;Shaw P;Gross A;Soslow R;Parkash V;Shih IeM;Kurman RJ
有令人信服的证据表明，浆液性输卵管上皮内癌（STIC）是高级别浆液性卵巢癌的前兆。现在需要大规模的研究来确定其生物学意义和临床意义。在进行这些研究之前，需要对STIC进行可重复的分类，这就是本研究的目标。这项研究涉及来自4个学术机构的6名妇科病理学家和3轮独立审查。在第1轮中，由5名病理学家根据预先确定的形态学标准对67个病变进行分类，范围从正常、非典型到STIC。观察者间诊断STIC与非STIC的一致性一般[κ=0.39; 95%可信区间（CI）0.26，0.52]，根据一致性百分比和κ，观察者内的重复性范围从一般到中等。第2轮涉及由3名病理学家在10组中测试修订后的标准，该标准纳入了p53蛋白表达和Ki-67标记的形态学和免疫组织化学（IHC）。结果是观察者间对STIC分类的一致性有所提高（κ=0.62; 95%CI 0.18，1.00）。然后结合p53和Ki-67的形态学和IHC创建算法，并作为第3轮的一部分评估再现性。在6名病理学家审查的37处病变中，观察到STIC与无STIC的基本一致性（κ=0.73; 95% CI 0.58，0.86）。总之，我们已经制定了可重复的标准诊断STIC，包括形态学和免疫组化标记的p53和Ki-67。我们提出的算法，预计将有助于标准化的分类STIC为未来的研究。
There is compelling evidence that serous tubal intraepithelial carcinoma (STIC) is a precursor of high-grade serous ovarian carcinoma. Large-scale studies are now required to determine its biological significance and clinical implication. Before conducting these studies, a reproducible classification for STIC is needed, and that is the goal of this study. This study involved 6 gynecologic pathologists from 4 academic institutions and 3 independent rounds of review. In round 1, sixty-seven lesions ranging from normal, atypical, to STICs were classified by 5 pathologists on the basis of predetermined morphologic criteria. Interobserver agreement for the diagnosis of STIC versus not STIC was fair [κ=0.39; 95%confidence interval (CI) 0.26, 0.52], and intraobserver reproducibility ranged from fair to moderate on the basis of percentage agreement and κ. Round 2 involved testing revised criteria that incorporated morphology and immunohistochemistry (IHC) for p53 protein expression and Ki-67 labeling in 10 sets by 3 of the pathologists. The result was an improvement in interobserver agreement for the classification of STIC (κ=0.62; 95% CI 0.18, 1.00). An algorithm was then created combining morphology and IHC for p53 and Ki-67, and reproducibility was assessed as part of round 3. In 37 lesions reviewed by 6 pathologists, substantial agreement for STIC versus no STIC was observed (κ=0.73; 95% CI 0.58, 0.86). In conclusion, we have developed reproducible criteria for the diagnosis of STIC that incorporate morphologic and IHC markers for p53 and Ki-67. The algorithm we propose is expected to help standardize the classification of STIC for future studies.