Krivokapić Zoran, Marković Srdjan, Antić Jadranka, Dimitrijević Ivan, Bojić Daniela, Svorcan Petar, Jojić Njegica, Damjanović Svetozar
First Surgical Clinic, Koste Todorovica 6, 11000 Belgrade, Serbia.
Croat Med J. 2012 Aug;53(4):328-35. doi: 10.3325/cmj.2012.53.328.
To assess practical accuracy of revised Bethesda criteria (BGrev), pathological predictive model (MsPath), and histopathological parameters for detection of high-frequency of microsatellite instability (MSI-H) phenotype in patients with colorectal carcinoma (CRC).
Tumors from 150 patients with CRC were analyzed for MSI using a fluorescence-based pentaplex polymerase chain reaction technique. For all patients, we evaluated age, sex, family history of cancer, localization, tumor differentiation, mucin production, lymphocytic infiltration (TIL), and Union for International Cancer Control stage. Patients were classified according to the BGrev, and the groups were compared. The utility of the BGrev, MsPath, and clinical and histopathological parameters for predicting microsatellite tumor status were assessed by univariate logistic regression analysis and by calculating the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values.
Fifteen out of 45 patients who met and 4 of 105 patients who did not meet the BGrev criteria had MSI-H CRC. Sensitivity, specificity, PPV, and NPV for BGrev were 78.9%, 77%, 30%, and 70%, respectively. MSI histology (the third BGrev criterion without age limit) was as sensitive as BGrev, but more specific. MsPath model was more sensitive than BGrev (86%), with similar specificity. Any BGrev criterion fulfillment, mucinous differentiation, and right-sided CRC were singled out as independent factors to identify MSI-H colorectal cancer.
The BGrev, MsPath model, and MSI histology are useful tools for selecting patients for MSI testing.
评估修订后的贝塞斯达标准（BGrev）、病理预测模型（MsPath）以及组织病理学参数在检测结直肠癌（CRC）患者微卫星高度不稳定（MSI-H）表型中的实际准确性。
采用基于荧光的五重聚合酶链反应技术对150例CRC患者的肿瘤进行微卫星不稳定性分析。对所有患者，我们评估了年龄、性别、癌症家族史、肿瘤定位、肿瘤分化程度、黏液产生情况、淋巴细胞浸润（TIL）以及国际癌症控制联盟分期。患者根据BGrev进行分类，并对各分组进行比较。通过单因素逻辑回归分析以及计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），评估BGrev、MsPath以及临床和组织病理学参数对微卫星肿瘤状态的预测效用。
符合BGrev标准的45例患者中有15例以及不符合BGrev标准的105例患者中有4例患有MSI-H CRC。BGrev的敏感性、特异性、PPV和NPV分别为78.9%、77%、30%和70%。MSI组织学（无年龄限制的第三条BGrev标准）与BGrev敏感性相同，但特异性更高。MsPath模型比BGrev更敏感（86%），特异性相似。满足任何BGrev标准、黏液性分化以及右侧CRC被确定为识别MSI-H结直肠癌的独立因素。
BGrev、MsPath模型以及MSI组织学是选择进行MSI检测患者的有用工具。
