Debating deposits: an interobserver variability study of lymph nodes and pericolonic tumor deposits in colonic adenocarcinoma.
Debating deposits: an interobserver variability study of lymph nodes and pericolonic tumor deposits in colonic adenocarcinoma.
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DOI：
10.5858/arpa.2013-0166-oa
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发表时间：
2014-05
影响因子：
4.6
通讯作者：
Frankel WL
中科院分区：
文献类型：
--
作者：
Rock JB;Washington MK;Adsay NV;Greenson JK;Montgomery EA;Robert ME;Yantiss RK;Lehman AM;Frankel WL
AJCC第7版艾德将结肠周围肿瘤沉积物（TD）定义为结肠周围脂肪中不连续的肿瘤病灶，没有残留淋巴结（LN）的证据。这个定义依赖于主观特征，而不是大小（第5）或形状（第6），并引入了类别N1 c。虽然通常是直接的，但在LN和TD之间的区别不清楚的情况下会遇到转移。为了使数据有意义，需要就阳性LN和TD之间的区别特征达成一致。我们评估了胃肠道病理学家对难治性转移的一致性，并报告了一系列他们发现有帮助的区别特征。选择来自右侧结肠腺癌的肿瘤转移（25例），其中阳性LN和TD之间的区别具有挑战性。由7名GI病理学家审查虚拟切片。每位病理学家对可能有助于区分阳性LN和TD的特征列表进行有用性排名。所有转移灶均诊断为LN或TD阳性。对于诊断为LN阳性的每个病例，评审员列出了诊断中使用的每个特征。在11/25个转移灶、5个阳性LN和6个TD中发现完全一致（kappa统计量，0.4; 95%CI，0.28，0.67）。排在前列的特征包括圆形、外周淋巴细胞边缘、外周淋巴滤泡、可能的包膜下窦、周围脂肪中的LN和厚包膜。最常用的功能相似。评价人员之间存在着很大的一致性，但仍然存在不一致性。我们发现圆形、淋巴滤泡、外周淋巴细胞边缘、周围脂肪中的LN、可能的包膜下窦和厚包膜是最常用于辅助诊断LN的特征。
The AJCC 7th Ed defines pericolonic tumor deposits (TD) as discrete tumor foci in pericolic fat showing no evidence of residual lymph node (LN). This definition relies on subjective features rather than size (5th) or shape (6th) and introduced the category N1c. While typically straightforward, metastases are encountered where distinction between LN and TD is unclear. For data to be meaningful, agreement on distinguishing features between positive LN and TD is needed. We evaluated the agreement between GI pathologists on difficult metastases and report a list of distinguishing features they found helpful. Tumor metastases (25) from right-sided colonic adenocarcinomas were selected where distinction between positive LN and TD was challenging. Virtual slides were reviewed by 7 GI pathologists. A list of features potentially helpful in differentiating positive LN and TD was ranked for usefulness by each pathologist. Every metastasis was diagnosed as positive LN or TD. For each case diagnosed as positive LN, reviewers listed every feature used in diagnosis. Complete agreement was found in 11/25 metastases, 5 positive LN and 6 TD (kappa statistic, 0.4; 95% CI, 0.28, 0.67). Top ranked features included round shape, peripheral lymphocyte rim, peripheral lymphoid follicles, possible subcapsular sinus, LN in surrounding fat and thick capsule. Top utilized features were similar. Significant agreement between evaluators existed, but inconsistency remains. We found that round shape, lymphoid follicles, peripheral lymphocyte rim, LN in surrounding fat, possible subcapsular sinus and thick capsule were most often used to aid in LN diagnosis.