Malouf G, Falissard B, Azoulay D, Callea F, Ferrell L D, Goodman Z D, Hayashi Y, Hsu H-C, Hubscher S G, Kojiro M, Ng I O, Paterson A C, Reynes M, Zafrani E-S, Emile J-F
EA4340, Versailles SQY University and Ambroise Paré Hospital, APHP, Boulogne, France.
J Clin Pathol. 2009 Jun;62(6):519-24. doi: 10.1136/jcp.2008.062620. Epub 2009 Jan 20.
In the era of targeted therapeutics, histological typing of hepatobiliary carcinomas has major clinical implications. Little is known about the reproducibility of the pathological diagnosis of primary liver carcinomas. Therefore, this study aimed to evaluate the worldwide variation in the pathological expert diagnoses of primary liver carcinomas with fibrous stroma in patients who did not have cirrhosis.
A single set of slides was selected from 25 tumours, and this set was reviewed independently by 12 pathologists who have worldwide expertise in liver tumours. Reproducibility of the diagnoses was evaluated by Light's kappa, and diagnoses were clustered by multidimensional scaling. Immunohistochemistry was performed after histological review.
The interobserver reproducibility for diagnosis of hepatocellular carcinoma subtypes and cholangiocarcinomas was poor (kappa 0.23-0.52), even when the experts considered that the diagnosis required no additional stains or clinical information. Interestingly, multidimensional scaling revealed three main clusters of tumours: hepatocellular carcinoma with no other specifications (n = 13), fibrolamellar hepatocellular carcinoma (n = 3) and cholangiocarcinoma (n = 9). Using immunohistochemistry, these histological clusters correlated with expression of anti-hepatocyte and anti-cytokeratin 19 (p<0.001).
The results demonstrate the poor reproducibility among experts of the pathological diagnosis of primary liver carcinomas with fibrous stroma in patients who did not have cirrhosis, and highlight that the systematic use of immunohistochemistry may improve the diagnostic accuracy.
在靶向治疗时代，肝胆癌的组织学分类具有重要的临床意义。关于原发性肝癌病理诊断的可重复性知之甚少。因此，本研究旨在评估全球范围内对无肝硬化患者原发性肝癌伴纤维基质的病理专家诊断的差异。
从25个肿瘤中选取一组切片，由12位在全球范围内具有肝脏肿瘤专业知识的病理学家独立进行评估。通过Light卡方检验评估诊断的可重复性，并通过多维标度法对诊断结果进行聚类分析。组织学检查后进行免疫组织化学检测。
即使专家认为诊断不需要额外的染色或临床信息，观察者间对肝细胞癌亚型和胆管癌诊断的可重复性也较差（卡方值为0.23 - 0.52）。有趣的是，多维标度法显示肿瘤主要分为三个聚类：无其他特殊情况的肝细胞癌（n = 13）、纤维板层型肝细胞癌（n = 3）和胆管癌（n = 9）。通过免疫组织化学检测发现，这些组织学聚类与抗肝细胞和抗细胞角蛋白19的表达相关（p<0.001）。
结果表明，对于无肝硬化患者原发性肝癌伴纤维基质的病理诊断，专家之间的可重复性较差，并强调系统使用免疫组织化学可能会提高诊断准确性。
