Department of Cellular Pathology, John Radcliffe Hospital and University of Oxford, OX3 9DU Oxford, UK.
Hum Pathol. 2012 Nov;43(11):1917-23. doi: 10.1016/j.humpath.2012.01.020. Epub 2012 May 8.
The aim of this study was to ascertain the level of concordance among gastrointestinal pathologists for regression grading in rectal cancers treated with neoadjuvant chemoradiation. Seventeen gastrointestinal pathologists participated using the Mandard, Dworak, and modified rectal cancer regression grading systems to grade 10 representative slides that were selected from 10 cases of rectal cancer treated with long-course neoadjuvant chemoradiation. The slides were scanned with a whole-slide scanner generating dynamic digitized images. The results showed very little concordance across the 3 grading systems, with κ values of 0.28, 0.35, and 0.38 for the Mandard, Dworak, and modified rectal cancer regression grading systems, respectively. In only 1 of 10 study cases was there unanimous grading concordance using the modified rectal cancer regression grading system. It was felt that these systems lacked precision and clarity for reproducible, accurate regression grading. The study concluded that there was a need for a simple, reproducible regression grading system with clear criteria, a cumulative or composite score taking into account all sections of the tumor bed that is sampled rather than the worst section (highest grade), and there should be a uniform method of sampling of these specimens.
本研究旨在确定接受新辅助放化疗治疗的直肠癌患者的胃肠道病理学家在回归分级方面的一致性程度。17 位胃肠道病理学家使用 Mandard、Dworak 和改良直肠肿瘤消退分级系统，对 10 例接受长程新辅助放化疗的直肠癌患者的 10 个代表性切片进行分级。这些切片使用全切片扫描仪进行扫描，生成动态数字化图像。结果显示，这 3 种分级系统之间的一致性非常低，Mandard、Dworak 和改良直肠肿瘤消退分级系统的κ 值分别为 0.28、0.35 和 0.38。在 10 例研究病例中，只有 1 例使用改良直肠肿瘤消退分级系统进行了一致的分级。研究人员认为，这些系统缺乏精确性和清晰度，无法进行可重复、准确的回归分级。该研究得出结论，需要一种简单、可重复的回归分级系统，该系统应具有明确的标准，采用累积或综合评分，考虑到肿瘤床所有取样部位，而不仅仅是最差部位（最高等级），并且应该采用统一的方法对这些标本进行取样。
