Department of Pathology, Belfast Health and Social Care Trust, Northern Ireland.
Am J Surg Pathol. 2011 Feb;35(2):289-94. doi: 10.1097/PAS.0b013e3182073ac0.
The histologic assessment of cervical involvement in endometrial carcinoma may be problematic for a number of reasons, but an accurate evaluation of this is important for correct staging, dictating the need for adjuvant therapy, and prognostication. In this study, we assessed interobserver variation in the evaluation of cervical involvement in hysterectomy specimens of endometrial carcinoma among 6 specialist gynecologic pathologists. Seventy-six cases of endometrial carcinoma enriched for cases exhibiting some perceived issue in the assessment of cervical involvement were used. In all the cases, a single slide of the primary tumor in the uterine corpus and a single slide of the cervix were circulated among the 6 participants who filled in a proforma. On the basis of the responses, the tumors were staged according to the 1988 International Federation of Gynecology and Obstetrics (FIGO) staging system (I, IIA, IIB) and the 2009 FIGO staging system (I, II). Using the 1988 FIGO staging system, the unweighted and weighted κ values between individual observers ranged from 0.3115 to 0.6139 (average 0.4675) and from 0.3492 to 0.6533 (average 0.5065), respectively. The κ values between observers for the 2009 FIGO staging system ranged from 0.3481 to 0.6862 (average 0.4908). Although enriched for problematic cases, our study shows that there is at most a fair-to-good agreement among specialist gynecologic pathologists in the assessment of cervical involvement in endometrial carcinoma. Problematic factors include determination of the junction between the lower uterine segment and upper endocervix, the distinction between "floaters" and true cervical glandular involvement, the distinction between cervical glandular involvement and stromal involvement, and the distinction between cervical glandular involvement and reactive non-neoplastic lesions of the endocervical glands. There is a need for specialist pathology groups dealing with gynecologic cancers to develop and disseminate recommendations regarding the assessment of cervical involvement in endometrial carcinoma.
由于多种原因，评估子宫内膜癌的宫颈受累情况可能存在问题，但准确评估这一点对于正确分期、决定是否需要辅助治疗以及预测预后非常重要。在这项研究中，我们评估了 6 名妇科病理学家在评估子宫内膜癌子宫切除标本中宫颈受累情况方面的观察者间差异。使用了 76 例富含一些评估宫颈受累问题的子宫内膜癌病例。在所有病例中，均向 6 名参与者分发了一份子宫体原发肿瘤的单个幻灯片和宫颈的单个幻灯片，并填写了一份表格。根据回答，肿瘤按照 1988 年国际妇产科联合会（FIGO）分期系统（I、IIA、IIB）和 2009 年 FIGO 分期系统（I、II）进行分期。使用 1988 年 FIGO 分期系统，个别观察者之间的未加权和加权κ值范围为 0.3115 至 0.6139（平均 0.4675）和 0.3492 至 0.6533（平均 0.5065）。2009 年 FIGO 分期系统观察者之间的κ值范围为 0.3481 至 0.6862（平均 0.4908）。尽管本研究针对的是有问题的病例，但结果表明，妇科病理学家在评估子宫内膜癌的宫颈受累情况方面最多只有中等至良好的一致性。有问题的因素包括确定下段子宫和上段宫颈的交界处、区分“漂浮物”和真正的宫颈腺体受累、区分宫颈腺体受累和间质受累、以及区分宫颈腺体受累和宫颈腺体的反应性非肿瘤性病变。处理妇科癌症的专业病理小组有必要制定和传播有关评估子宫内膜癌宫颈受累情况的建议。
