甲状腺乳头状癌最小甲状腺外侵犯病理识别中的观察者间差异
Inter-Observer Variation in the Pathologic Identification of Minimal Extrathyroidal Extension in Papillary Thyroid Carcinoma.
作者信息
Su Henry K, Wenig Bruce M, Haser Grace C, Rowe Meghan E, Asa Sylvia L, Baloch Zubair, Du Eugenie, Faquin William C, Fellegara Giovanni, Giordano Thomas, Ghossein Ronald, LiVolsi Virginia A, Lloyd Ricardo, Mete Ozgur, Ozbek Umut, Rosai Juan, Suster Saul, Thompson Lester D, Turk Andrew T, Urken Mark L
机构信息
1 Department of Otolaryngology-Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York.
2 Department of Pathology, Mount Sinai Beth Israel, New York, New York.
出版信息
Thyroid. 2016 Apr;26(4):512-7. doi: 10.1089/thy.2015.0508.
BACKGROUND
Extrathyroidal extension (ETE) is a significant prognostic factor in papillary thyroid carcinoma (PTC). Minimal extrathyroidal extension (mETE) is characterized by involvement of the sternothyroid muscle or perithyroid soft tissue, and is generally identified by light microscope examination. Patients with mETE, identified pathologically, are automatically upstaged to pT3. However, the prognostic implications of mETE have been a source of controversy in the literature. Moreover, there is also controversy surrounding the identification of mETE on pathological specimens. The objective of this study was to determine the level of agreement among expert pathologists in the identification of mETE in PTC cases.
METHODS
Eleven expert pathologists from the United States, Italy, and Canada were asked to perform a review of 69 scanned slides of representative permanent sections of PTC specimens. Each slide was evaluated for the presence of mETE. The pathologists were also asked to list the criteria they use to identify mETE.
RESULTS
The overall strength of agreement for identifying mETE was slight (κ = 0.14). Inter-pathologist agreement was best for perithyroidal skeletal muscle involvement (κ = 0.46, moderate agreement) and worst for invasion around thick-walled vascular structures (κ = 0.02, slight agreement). In addition, there was disagreement over the constellation of histologic features that are diagnostic for mETE, which affected overall agreement for diagnosing mETE.
CONCLUSIONS
Overall agreement for the identification of mETE is poor. Disagreement is a result of both variation in individual pathologists' interpretations of specimens and disagreement on the histologic criteria for mETE. Thus, the utility of mETE in staging and treatment of PTC is brought into question. The lack of concordance may explain the apparent lack of agreement regarding the prognostic significance of this pathologic feature.
背景
甲状腺外侵犯（ETE）是甲状腺乳头状癌（PTC）的一个重要预后因素。微小甲状腺外侵犯（mETE）的特征是胸骨甲状肌或甲状腺周围软组织受累，通常通过光学显微镜检查来确定。经病理检查确诊为mETE的患者会自动被归为pT3期。然而，mETE的预后意义在文献中一直存在争议。此外，在病理标本上识别mETE也存在争议。本研究的目的是确定专家病理学家在识别PTC病例中的mETE方面的一致程度。
方法
邀请了来自美国、意大利和加拿大的11位专家病理学家对69张PTC标本代表性永久切片的扫描玻片进行评估。每张玻片都评估是否存在mETE。病理学家还被要求列出他们用于识别mETE的标准。
结果
识别mETE的总体一致性强度较弱（κ = 0.14）。病理学家之间对于甲状腺周围骨骼肌受累的一致性最好（κ = 0.46，中度一致），而对于厚壁血管结构周围侵犯的一致性最差（κ = 0.02，微弱一致）。此外，对于诊断mETE的组织学特征组合存在分歧，这影响了诊断mETE的总体一致性。
结论
识别mETE的总体一致性较差。分歧是由于个体病理学家对标本的解释存在差异以及对mETE的组织学标准存在分歧。因此，mETE在PTC分期和治疗中的实用性受到质疑。缺乏一致性可能解释了关于这一病理特征的预后意义明显缺乏共识的原因。
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