Wang L M, Guy R, Fryer E, Kartsonaki C, Gill P, Hughes C, Szuts A, Perera R, Chetty R, Mortensen N
Department of Cellular Pathology, John Radcliffe Hospital, University of Oxford, Headington, Oxford, UK.
Department of Colorectal Surgery, Churchill Hospital, University of Oxford, Headington, Oxford, UK.
Colorectal Dis. 2015 Aug;17(8):674-81. doi: 10.1111/codi.12910.
Early pT1 polyp colorectal cancers (CRCs) present challenges for accurate pathology substaging. Haggitt and Kikuchi stages depend on polyp morphology and are often difficult to apply due to suboptimal orientation or fragmentation, or absence of the muscularis propria in polypectomy or submucosal resection specimens. European guidelines for quality assurance suggest using Ueno's more objective approach, using depth and width measurements beyond muscularis mucosae. We have investigated interobserver variation using Ueno's approach.
Ten consecutive pT1 polyp CRCs were identified and the slides assessed by six gastrointestinal pathologists for depth and width of invasion. A further 60 polyps were studied by a group of specialist and general pathologists. Agreement was assessed by analysis of variance. A polyp CRC is classified as high risk if it has a depth ≥ 2000 μm or a width ≥ 4000 μm and low risk with a depth < 2000 μm or a width < 4000 μm. Concordance for the dichotomized values was assessed using the kappa statistic.
The intraclass correlation coefficient (ICC) for depth was 0.83 and for width 0.56 in the 10-polyp group. The ICC for the 60-polyp CRCs was 0.67 for depth and 0.37 for width. In both groups, when polyp CRCs are divided into high- and low-risk categories based on depth, there was substantial and moderate agreement (κ = 0.80 and 0.47) but only fair agreement when based on width (κ = 0.34 and 0.35).
Ueno's method has the advantage of being independent of polyp morphology. Our study shows better concordance for depth measurement and reproducibility in nonfragmented specimens, with poorer agreement when based on width.
早期pT1息肉型结直肠癌（CRC）在准确的病理亚分期方面存在挑战。哈吉特（Haggitt）和菊池（Kikuchi）分期取决于息肉形态，由于定位欠佳、组织破碎，或息肉切除或黏膜下切除标本中缺乏固有肌层，这些分期往往难以应用。欧洲质量保证指南建议采用上野（Ueno）更客观的方法，测量超出黏膜肌层的深度和宽度。我们使用上野的方法研究了观察者间的差异。
连续鉴定出10例pT1息肉型CRC，6名胃肠病理学家对切片进行侵袭深度和宽度评估。另一组专科和普通病理学家研究了另外60个息肉。通过方差分析评估一致性。如果息肉型CRC的深度≥2000μm或宽度≥4000μm，则分类为高风险；如果深度<2000μm或宽度<4000μm，则分类为低风险。使用kappa统计量评估二分值的一致性。
在10个息肉组中，深度的组内相关系数（ICC）为0.83，宽度为0.56。60个息肉型CRC的深度ICC为0.67，宽度为0.37。在两组中，当根据深度将息肉型CRC分为高风险和低风险类别时，一致性较高和中等（κ = 0.80和0.47），但根据宽度时一致性仅为一般（κ = 0.34和0.35）。
上野的方法具有独立于息肉形态的优点。我们的研究表明，在完整标本中，深度测量的一致性和可重复性更好，而基于宽度时一致性较差。
