Köbel Martin, Bak Julia, Bertelsen Björn I, Carpen Olli, Grove Anni, Hansen Estrid S, Levin Jakobsen Anne-Marie, Lidang Marianne, Måsbäck Anna, Tolf Anna, Gilks C Blake, Carlson Joseph W
Department of Pathology and Laboratory Medicine, Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada.
Histopathology. 2014 Jun;64(7):1004-13. doi: 10.1111/his.12349. Epub 2014 Mar 7.
To assess the variation in ovarian carcinoma type diagnosis among gynaecological pathologists from Nordic countries, and whether a rationally designed panel of immunohistochemical markers could improve diagnostic reproducibility.
Eight pathologists from four countries (Sweden, Denmark, Norway, and Finland) received an educational lecture on the diagnosis of ovarian carcinoma type. All tumour-containing slides from 54 ovarian carcinoma cases were independently reviewed by the participants, who: (i) determined type purely on the basis of histology; (ii) indicated whether they would apply immunohistochemistry in their routine practice; and (iii) determined type after reviewing the staining results. The results for six markers (WT1, p53, p16, HNF-1β, ARID1A, and progesterone receptor) were determined for all 54 cases, by staining of a tissue microarray. The median concordance with central review diagnosis was 86%, and significantly improved to 90% with the incorporation of immunostaining results (P = 0.0002). The median interobserver agreement was 78%, and significantly improved to 85% with the incorporation of immunostaining results (P = 0.0002).
Use of the immunostaining results significantly improved both diagnostic accuracy and interobserver agreement. These results indicate that ovarian carcinoma type can be reliably diagnosed by pathologists from different countries, and also demonstrate that immunohistochemistry has an important role in improving diagnostic accuracy and agreement between pathologists.
评估北欧国家妇科病理学家对卵巢癌类型诊断的差异，以及一组合理设计的免疫组化标志物能否提高诊断的可重复性。
来自四个国家（瑞典、丹麦、挪威和芬兰）的八位病理学家参加了关于卵巢癌类型诊断的教育讲座。参与者对54例卵巢癌病例中所有含肿瘤的切片进行独立评估，他们：（i）纯粹基于组织学确定类型；（ii）表明他们在日常实践中是否会应用免疫组化；（iii）在查看染色结果后确定类型。通过组织微阵列染色，对所有54例病例测定了六种标志物（WT1、p53、p16、HNF-1β、ARID1A和孕激素受体）的结果。与中心评估诊断的中位一致性为86%，纳入免疫染色结果后显著提高到90%（P = 0.0002）。观察者间的中位一致性为78%，纳入免疫染色结果后显著提高到85%（P = 0.0002）。
使用免疫染色结果显著提高了诊断准确性和观察者间的一致性。这些结果表明，不同国家的病理学家能够可靠地诊断卵巢癌类型，也证明了免疫组化在提高诊断准确性和病理学家之间的一致性方面具有重要作用。
