A Consensus Study of the Grading and Typing of Intraductal Papillary Mucinous Neoplasms of the Pancreas.
A Consensus Study of the Grading and Typing of Intraductal Papillary Mucinous Neoplasms of the Pancreas.
复制标题
胰腺导管内乳头状粘液性肿瘤分级和分型的共识研究。
DOI：
10.1097/mpa.0000000000001270
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Okazaki K.
中科院分区：
文献类型：
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作者：
Furukawa T;Fukushima N;Itoi T;Ohike N;Mitsuhashi T;Nakagohri T;Notohara K;Shimizu M;Tajiri T8;Tanaka M9;Yamaguchi H;Yanagisawa A;Sugiyama M;Okazaki K.
胰腺导管内乳头状黏液性肿瘤（IPMNs）的分级和分型一直是病理学家的难题。我们的目的是澄清在评估IPMN的等级和类型的一致性和分歧点。方法由10名日本病理学家独立评估20个IPMN的数字切片图像，然后举行共识会议，讨论分歧点，并形成共识和建议。结果等级和类型的平均一致率为83.5%。（范围，100%-40%）和82.5% Fleiss' κ值分别为0.567和0.636。结论对乳腺导管壁破坏伴脱落的癌性上皮细胞或部分衬有癌性细胞的粘液湖可作为乳腺癌浸润的标志;除非存在血管或淋巴管浸润，否则导管内间质浸润可被排除;弹力纤维染色可帮助显示胶样结节中的导管;通过肠乳头中明显的核排列紊乱和复杂的结构，可将高级别与低/中级别区分开来;嗜酸细胞乳头的特征是具有圆形定向紊乱核的嗜酸性细胞;高级别胃乳头可以通过相对低但复杂的结构与胰胆乳头区分开;并且最发育不良的乳头应该用于评估混合乳头类型中的类型。
ObjectiveThe grading and typing of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are challenging for pathologists. We aimed to clarify the points of consistency and disagreement in assessing the grades and types of IPMNs.MethodsDigital slide images of 20 IPMNs were independently assessed by 10 Japanese pathologists, who then held a consensus meeting to discuss the points of disagreement and develop a consensus and recommendations.ResultsThe average agreement rates for grade and type were 83.5%(range, 100%–40%) and 82.5%(range, 100%–50%) and the Fleiss' κ values were 0.567 and 0.636, respectively.ConclusionsThe disagreement points and recommendations were as follows: destructed ductal walls with desquamated neoplastic epithelia or mucin lakes partially lined with neoplastic cells could be invasion; intraductal stromal invasion could be dismissed unless vascular or lymphatic invasion existed; elastica staining may help visualize ducts in colloidal nodules; high-grade can be distinguished from low/intermediate grade by marked nuclear disarrangements and complex architecture in the intestinal papillae; oncocytic papillae are characterized by eosinophilic cells with round disoriented nuclei; high-grade gastric papillae can be distinguished from pancreatobiliary papillae by relatively low but complex architecture; and the most dysplastic papillae should be used to assess type in mixed papillae types.