*Department of Pathology and Molecular Medicine †Department of Pathology and Molecular Medicine, Juravinski Hospital ‡School of Nursing §Department of Clinical Epidemiology and Biostatistics ∥Department of Pathology and Molecular Medicine, McMaster University Medical Centre, McMaster University, Hamilton #Department of Pathology, St Joseph's Hospital **Department of Pathology, Mt Sinai Hospital, University of Toronto, Toronto, ON ¶British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada ††Department of Pathology, Brigham and Women's Hospital ‡‡Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Am J Surg Pathol. 2013 Sep;37(9):1336-41. doi: 10.1097/PAS.0b013e31829f306a.
Invasive squamous cell carcinoma of the vulva with ≤1 mm stromal invasion is classified as stage 1A. Cancer staging systems state that the depth of invasion should be measured from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of the invasive tumor. Measurement of the depth of invasion guides patient management. Even though this measurement is critical, no studies have reported the reliability among pathologists for determining the cutoff point of ≤1 mm stromal invasion in vulvar cancer. We assessed agreement among pathologists for determining whether a vulvar tumor is invasive, for the depth of invasion, and for tumor thickness. Forty-five cases of vulvar squamous cell carcinoma with a depth of invasion of ≤5 mm were chosen. Eleven gynecologic pathologists independently reviewed the slides and, for a subset of cases, pictorially recorded measurements on photographs. The number of cases that were reported as invasive by the 11 pathologists ranged from 21 to 44. The number of cases that were reported as showing a depth of invasion of ≤1 mm ranged from 7 to 27. Eight pathologists provided measurements for all lesions reported as invasive, the remaining 3 pathologists stated that they were unable to measure 2, 7, and 16 lesions, respectively. Mean κ for diagnosing vulvar carcinoma as invasive was 0.24 and for measuring the depth of invasion and thickness was 0.51 and 0.49, respectively. There was only fair agreement in determining whether the lesion was invasive. In cases in which pathologists agreed upon the diagnosis of invasion, agreement on depth was moderate. When using the recommended cancer staging method, interpretation of the location of the most superficial dermal papilla varied among pathologists. Measuring thickness did not improve agreement. This is the first study that has assessed the reliability of the diagnosis of invasion in vulvar cancer among gynecologic pathologists, the interobserver agreement for reporting the critical 1 mm threshold of depth of stromal invasion, and the way in which the International Federation of Gynecology and Obstetrics method is used by pathologists.
外阴浸润性鳞状细胞癌，间质浸润深度≤1mm，归类为 1A 期。癌症分期系统规定，浸润深度应从相邻最浅表真皮乳头的上皮-间质交界处测量至侵袭性肿瘤的最深处。浸润深度的测量指导患者管理。尽管这一测量至关重要，但尚无研究报告外阴癌中≤1mm 间质浸润的临界值在病理学家之间的可靠性。我们评估了病理学家在确定外阴肿瘤是否浸润、浸润深度和肿瘤厚度方面的一致性。选择了 45 例浸润深度≤5mm 的外阴鳞状细胞癌病例。11 位妇科病理学家独立地对切片进行了复查，并且在部分病例中，在照片上记录了测量结果。11 位病理学家报告为浸润性的病例数量从 21 例到 44 例不等。报告为浸润深度≤1mm 的病例数量从 7 例到 27 例不等。8 位病理学家为所有报告为浸润性的病变提供了测量值，其余 3 位病理学家分别表示无法测量 2、7 和 16 例病变。诊断外阴癌为浸润性的平均κ 值为 0.24，测量浸润深度和厚度的κ 值分别为 0.51 和 0.49。在确定病变是否浸润方面，仅存在适度的一致性。在病理学家一致诊断为浸润的病例中，对深度的判断为中度一致。当使用推荐的癌症分期方法时，病理学家对最浅表真皮乳头位置的解读存在差异。测量厚度并不能提高一致性。这是第一项评估妇科病理学家诊断外阴癌浸润的可靠性、报告间质浸润临界值 1mm 的观察者间一致性以及国际妇产科联盟方法被病理学家使用方式的研究。
