Douglas Gregory, Howitt Brooke E, Schoolmeester John K, Schwartz Lauren, Kos Zuzana, Islam Shahidul, Djordjevic Bojana, Parra-Herran Carlos
The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
Pathol Res Pract. 2017 Jul;213(7):799-803. doi: 10.1016/j.prp.2017.03.008. Epub 2017 Mar 8.
Studies on the pattern-based classification for invasive endocervical adenocarcinoma showed that tumors with nondestructive invasion (pattern-A) have a 0% rate of nodal metastases. Our understanding of pattern-A tumors and their distinction from in-situ adenocarcinoma requires further study. Thirteen sections diagnosed independently as pattern-A adenocarcinoma by three gynecologic pathologists, and 14 sections of benign endocervix were selected. Three additional pathologists (reviewers) evaluated a digital image from each section and classified it as pattern-A or benign based on architecture only. To blind the interpretation to cytologic features, nuclei and cytoplasm were obscured using morphometric software (Zen 2011, Carl Zeiss Microscopy, Germany). 13/27 cases (48%; 8 pattern-A, 5 benign) were correctly classified by all reviewers; 19/27 (70%; 10 pattern-A, 9 benign) were correctly classified by ≥2 reviewers. 3/13 pattern-A cases (23%) were interpreted as benign by ≥2 reviewers. Conversely, 5/14 benign cervices (36%) were misinterpreted as pattern-A by ≥2 reviewers. The number of glands per 20× field was higher in pattern-A cases with high reviewer agreement (p=0.004). An abnormal architecture is seen in many pattern-A adenocarcinomas in support of their invasive nature; some, however, have architecture that overlaps with that of benign endocervix thus may actually represent in-situ lesions. Likewise, normal cervix can be architecturally complex and mirror patterns that pathologists would classify as pattern-A if malignant cytologic features were present. Based on this overlap and the nil risk of nodal spread, an emphasis on the non-destructive, rather than the invasive, nature of pattern-A adenocarcinoma is recommended.
关于浸润性宫颈腺癌基于模式的分类研究表明，具有非破坏性浸润（模式A）的肿瘤淋巴结转移率为0%。我们对模式A肿瘤及其与原位腺癌的区别的理解需要进一步研究。选取了由三位妇科病理学家独立诊断为模式A腺癌的13个切片，以及14个宫颈良性切片。另外三位病理学家（审阅者）评估了每个切片的数字图像，并仅根据结构将其分类为模式A或良性。为了使解释不受细胞学特征的影响，使用形态测量软件（Zen 2011，德国卡尔蔡司显微镜公司）将细胞核和细胞质进行了模糊处理。所有审阅者正确分类了27例中的13例（48%；8例模式A，5例良性）；≥2位审阅者正确分类了27例中的19例（70%；10例模式A，9例良性）。≥2位审阅者将13例模式A病例中的3例（23%）解释为良性。相反，≥2位审阅者将14个良性宫颈中的5例（36%）误判为模式A。在审阅者一致性高的模式A病例中，每20倍视野下的腺体数量更多（p = 0.004）。许多模式A腺癌可见异常结构，支持其浸润性本质；然而，有些模式A腺癌的结构与宫颈良性病变重叠，因此可能实际上代表原位病变。同样，正常宫颈在结构上可能很复杂，并且会呈现出如果存在恶性细胞学特征病理学家会分类为模式A的结构。基于这种重叠以及淋巴结转移的零风险，建议强调模式A腺癌的非破坏性而非浸润性本质。
