Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study
Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study
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DOI：
10.1136/jclinpath-2016-203947
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发表时间：
2017-03-01
影响因子：
3.4
通讯作者：
Chetty, Runjan
中科院分区：
文献类型：
--
作者：
Kalimuthu, Sangeetha N.;Serra, Stefano;Chetty, Runjan
目的对胰腺导管腺癌（PDAC）新辅助放化疗后的预后进行评估。本研究的目的是检查的实用性，再现性和水平的一致性的三个最常用的分级system.Methods四个胃肠道病理学家使用美国病理学家学院（CAP），埃文斯，MD安德森癌症中心（MDA）回归分级系统分级14个选定的情况下（7-20幻灯片从每例）的新辅助放化疗治疗PDAC。与每位病理学家进行评分后讨论。结果被输入到一个标准化的数据收集表格和统计分析performed.Results有在三个系统之间的一致性很小。Kendall一致性系数评分为：CAP：2-较差，2-一般; Evans：1-一般，1-中等，2-良好; MDA：1-较差，2-中等，1-良好。CAP分级系统中所有三个级别的口译是差异的来源。此外，使用纤维化作为评估退化的标准是有争议的。在Evans系统中，使用任意百分比临界值（即，9% vs 10%; 50% vs 51%等）定量肿瘤破坏是不精确和主观的。虽然MDA系统产生了最大的一致性，这是由于过度简化'周围广泛的，任意分配的阈值为5%的tumor.Conclusions所有系统缺乏精确度和清晰度，准确的回归分级。目前，组织学消退分级在患者管理中的临床效用和影响是值得怀疑的。有必要重新评估胰腺的退化分级，并建立一个可重复的，临床相关的分级系统。
Aim Several regression grading systems have been proposed for neoadjuvant chemoradiation-treated pancreatic ductal adenocarcinoma (PDAC). This study aimed to examine the utility, reproducibility and level of concordance of three most frequently used grading systems.Methods Four gastrointestinal pathologists used the College of American Pathologists (CAP), Evans, MD Anderson Cancer Centre (MDA) regression grading systems to grade 14 selected cases (7-20 slides from each case) of neoadjuvant chemoradiation-treated PDAC. A postscoring discussion with each pathologist was conducted. The results were entered into a standardised data collection form and statistical analyses were performed.Results There was little concordance across the three systems. The Kendall coefficient of concordance agreement scores were: CAP: 2-poor, 2-fair; Evans: 1-fair, 1-moderate, 2-good; MDA: 1-poor, 2-moderate, 1-good. Interpretation in all three grades in the CAP grading system was a source of discrepancy. Furthermore, using fibrosis as a criterion to assess regression was contentious. In the Evans system, quantifying tumour destruction using arbitrary percentage cut-offs (ie, 9% vs 10%; 50% vs 51%, etc) was imprecise and subjective. Although the MDA system generated greatest concordance, this was due to oversimplification' surrounding wide, arbitrarily assigned thresholds of 5% of tumour.Conclusions All systems lacked precision and clarity for accurate regression grading. Presently the clinical utility and impact of histological regression grading in patient management is questionable. There is a need to re-evaluate regression grading in the pancreas and establish a reproducible, clinically relevant grading system.