Histologic and immunohistochemical decision-making in endometrial adenocarcinoma
Histologic and immunohistochemical decision-making in endometrial adenocarcinoma
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DOI：
10.1038/modpathol.2008.97
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发表时间：
2008-08-01
期刊：
影响因子：
7.5
通讯作者：
Mutter, George L.
中科院分区：
文献类型：
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作者：
Lomo, Lesley;Nucci, Marisa R.;Mutter, George L.
弥漫性p53免疫染色可区分85%的浆液性（II型）和类浆液性（I型）癌，是预后不良的独立标志物。这些实体的诊断，以及p53免疫染色结果的选择和预测，观察者间的重现性是未知的。三位病理学家关于以下方面的可重复性：（1）两部分（I和II）和（2）三部分分类（I、II或不确定）;（3）p53染色的建议和（4）p53染色结果的预期使用kappa（k）统计量计算。所有病例均进行p53免疫染色并独立评分。一个两层和三层的分类方案实现了高（k = 0.71）和中等（k = 0.49）的重现性。与一致分类的病例（82例病例，14%的通过）相比，非一致病例更有可能被重新分类为“不确定”类别（27例病例，39%的通过）。病理学家推荐p53免疫染色的重现性较差（k = 0.28），但染色预测具有良好的一致性（69%，k = 0.50）。此外，p53染色在诊断不一致的病例中（46%）比一致的病例（16%）更常见。子宫内膜癌的一个亚组不容易符合两类系统，可以从以下病例中剔除：（1）观察者间不一致，（2）更可能被选择进行p53免疫染色，（3）更可能对p53染色阳性。由于p53是子宫内膜腺癌预后的重要标志物，并且在不确定的病例中无法提前预测，因此在二元系统中观察者不同意的病例中应使用p53免疫染色。
Diffuse p53 immunostaining distinguishes 85% of serous (Type II) from endometrioid (Type I) carcinomas and is an independent marker for poor prognosis. Interobserver reproducibility for the diagnosis of these entities, as well as selection and prediction of p53 immunostaining results, is unknown. Reproducibility of three pathologists regarding: (1) a two (I and II) and (2) three part classification (I, II or indeterminate); (3) recommendation for p53 staining and (4) expectations of p53 staining results were computed with the kappa (k) statistic. All cases were immunostained for p53 and independently scored. A two and three tiered classification scheme achieved high (k = 0.71) and moderate (k = 0.49) reproducibility. Non-unanimous cases were more likely to be reclassified into an 'indeterminate' category (27 cases, 39% of passes) compared to those with unanimous (82 cases, 14% of passes) classification. Pathologists recommended p53 immunostaining with poor (k = 0.28) reproducibility, but staining prediction was made with good concordance (69%, k = 0.50). Moreover, p53 staining was more common in diagnostically discordant (46%) compared to concordant (16%) cases. A subset of endometrial cancers do not readily fit within a two-class system and can be culled from cases that (1) do not achieve interobserver concordance and (2) are more likely to be chosen for p53 immunostaining and (3) are more likely to stain positive for p53. Because p53 is an important marker for endometrial adenocarcinoma outcome, and cannot be predicted in advance in indeterminate cases, p53 immunostaining should be employed in cases with observer disagreement in a binary system.