Kojima Motohiro, Puppa Giacomo, Kirsch Richard, Basturk Olca, Frankel Wendy L, Vieth Michael, Lugli Alessandro, Sheahan Kieran, Yeh Matthew, Lauwers Greg Y, Risio Mauro, Shimazaki Hideyuki, Iwaya Keiichi, Kage Masayoshi, Akiba Jun, Ohkura Yasuo, Horiguchi Shinichiro, Shomori Kohei, Kushima Ryoji, Nomura Shogo, Ajioka Yoichi, Adsay Volkan, Ochiai Atsushi
Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba, Japan.
Department of Pathology, HôpitauxUniversitaires de Genève 1, Genève, Switzerland.
J Clin Pathol. 2015 Aug;68(8):628-32. doi: 10.1136/jclinpath-2014-202805. Epub 2015 Apr 30.
This study was performed to evaluate the concordance in pathological assessments of blood and lymphatic vessel invasion (BLI) in pT1 colorectal cancers and to assess the effect of diagnostic criterion on consistency in the assessment of BLI.
Forty consecutive patients undergoing surgical resection of pT1 colorectal cancers were entered into this study. H&E-stained, D2-40-stained and elastica-stained slides from the tumours were examined by 18 pathologists from seven countries. The 40 cases were divided into two cohorts with 20 cases each. In cohort 1, pathologists diagnosed BLI using criteria familiar to them; all Japanese pathologists used a criterion of BLI from the Japanese Society for Cancer of the Colon and Rectum (JSCCR). In cohort 2, all pathologists used the JSCCR diagnostic criterion.
In cohort 1, diagnostic concordance was moderate in the US/Canadian and European pathologists. There were no differences in the consistency compared with results for Japanese pathologists, and no improvement in the diagnostic concordance was found for using the JSCCR criterion. However, in cohort 2, the JSCCR criterion decreased the consistency of BLI diagnosis in the US/Canadian and European pathologists. The level of decreased consistency in the assessment of BLI was different between the US/Canadian and European pathologists.
A uniform criterion strongly influences the diagnostic consistency of BLI but may not always improve the concordance. Further study is required to achieve an objective diagnosis of BLI in colorectal cancer. The varying effects of diagnostic criterion on the pathologists from Japan, the USA/Canada and Europe might reflect varied interpretations of the criterion. Internationally accepted criterion should be developed by participants from around the world.
本研究旨在评估pT1期结直肠癌血液和淋巴管侵犯（BLI）病理评估的一致性，并评估诊断标准对BLI评估一致性的影响。
40例连续接受pT1期结直肠癌手术切除的患者纳入本研究。来自7个国家的18名病理学家对肿瘤的苏木精-伊红（H&E）染色、D2-40染色和弹性纤维染色切片进行检查。40例病例分为两个队列，各20例。在队列1中，病理学家使用他们熟悉的标准诊断BLI；所有日本病理学家使用日本结直肠癌学会（JSCCR）的BLI标准。在队列2中，所有病理学家使用JSCCR诊断标准。
在队列1中，美国/加拿大和欧洲病理学家的诊断一致性为中等。与日本病理学家的结果相比，一致性没有差异，使用JSCCR标准也未发现诊断一致性有所提高。然而，在队列2中，JSCCR标准降低了美国/加拿大和欧洲病理学家BLI诊断的一致性。美国/加拿大和欧洲病理学家在BLI评估中一致性降低的程度有所不同。
统一的标准对BLI的诊断一致性有很大影响，但不一定总能提高一致性。需要进一步研究以实现结直肠癌BLI的客观诊断。诊断标准对日本、美国/加拿大和欧洲病理学家的不同影响可能反映了对该标准的不同解读。应让世界各地的参与者制定国际公认的标准。
