Histopathological grading of pediatric ependymoma: reproducibility and clinical relevance in European trial cohorts.
Histopathological grading of pediatric ependymoma: reproducibility and clinical relevance in European trial cohorts.
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DOI：
10.1186/1477-5751-10-7
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发表时间：
2011-05-31
期刊：
影响因子：
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通讯作者：
Grundy RG
中科院分区：
文献类型：
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作者：
Ellison DW;Kocak M;Figarella-Branger D;Felice G;Catherine G;Pietsch T;Frappaz D;Massimino M;Grill J;Boyett JM;Grundy RG
室管膜瘤的组织病理学分级在其重复性和临床意义方面一直存在争议。在一项三阶段研究中，我们回顾了229例来自欧洲婴儿试验队列(2项试验-SFOP/CNS9204)和较大儿童试验(2项试验-AIEOP/CNS9904)的脑室管膜瘤的病理学，以评估五位神经病理学家之间的诊断一致性和组织病理学变量，特别是肿瘤分级对预后的有效性。在第一阶段，使用世界卫生组织的标准，在没有首先讨论任何与室管膜瘤分级相关的问题的情况下，病理学家对4个试验队列中的3个室管膜瘤进行了评估和独立分级。II级室管膜瘤的诊断频率低于III级，当在第二阶段重新评估一个队列(CNS9204)时，这种差异加剧，在此期间，病理学家讨论了室管膜瘤的分级，联合审查了所有CNS9204肿瘤，并根据WHO的分类定义了一个新的分级系统。在第三阶段，使用新系统对两个队列(SFOP/CNS9904)进行重复的独立审查与评分的一致性显著增加相关。在SFOP和AIEOP中，肿瘤切除程度与无进展生存期(PFS)显著相关，而在CNS9204和CNS9904中，肿瘤切除程度与无进展生存(PFS)无关。在只有一个试验队列(AIEOP)中，等级共识的强度与PFS显著相关。在AIEOP中，关于个体组织病理学特征(坏死、血管生成、细胞密度和有丝分裂活性)的评分与PFS相关的共识是一致的，但没有其他试验。我们得出结论，在WHO分类的基础上，使用更具说明性的方案可以提高室管膜瘤分级的一致性。不幸的是，这似乎在有限的临床环境中有实用价值。
Histopathological grading of ependymoma has been controversial with respect to its reproducibility and clinical significance. In a 3-phase study, we reviewed the pathology of 229 intracranial ependymomas from European trial cohorts of infants (2 trials - SFOP/CNS9204) and older children (2 trials - AIEOP/CNS9904) to assess both diagnostic concordance among five neuropathologists and the prognostic utility of histopathological variables, particularly tumor grading. In phase 1, using WHO criteria and without first discussing any issue related to grading ependymomas, pathologists assessed and independently graded ependymomas from 3 of 4 trial cohorts. Diagnosis of grade II ependymoma was less frequent than grade III, a difference that increased when one cohort (CNS9204) was reassessed in phase 2, during which the pathologists discussed ependymoma grading, jointly reviewed all CNS9204 tumors, and defined a novel grading system based on the WHO classification. In phase 3, repeat independent review of two cohorts (SFOP/CNS9904) using the novel system was associated with a substantial increase in concordance on grading. Extent of tumor resection was significantly associated with progression-free survival (PFS) in SFOP and AIEOP, but not in CNS9204 and CNS9904. Strength of consensus on grade was significantly associated with PFS in only one trial cohort (AIEOP). Consensus on the scoring of individual histopathological features (necrosis, angiogenesis, cell density, and mitotic activity) correlated with PFS in AIEOP, but in no other trial. We conclude that concordance on grading ependymomas can be improved by using a more prescribed scheme based on the WHO classification. Unfortunately, this appears to have utility in limited clinical settings.