Griffith Christopher C, Schmitt Alessandra C, Pantanowitz Liron, Monaco Sara E
Department of Pathology, Emory University, Atlanta, Georgia.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Cancer Cytopathol. 2017 Oct;125(10):776-785. doi: 10.1002/cncy.21906. Epub 2017 Aug 21.
Salivary gland aspiration cytology is useful in the preoperative management of patients but remains challenging, because of the extensive morphologic overlap of some tumors limits the ability to always determine the presence of malignancy. In response to this challenge, there has been increasing drive to develop a risk-based categorization scheme for salivary gland aspirates. Herein, the authors examine the interobserver variability of 1 such pattern and risk-based system.
Select smears and cell-block sections of 50 salivary gland aspirates from 2 large academic centers were digitally imaged. These scanned slides were independently and blindly reviewed by 4 cytopathologists, and each aspirate was assigned to 1 of the proposed pattern-based categories if it was considered neoplastic by the observer. Interobserver agreement was scored and aggregated risks of malignancy were calculated for cases with available surgical follow-up.
In total, 42 samples (84%) were considered neoplastic by at least 2 observers and were scored for interobserver agreement: 10 of 42 (23.8%) had uniform agreement, 14 of 42 (33.3%) had majority agreement, and 5 of 42 (11.9%) had divided agreement. Only 9 of 42 samples (21.4%) had minimal agreement, and 4 of 42 (9.5%) had no agreement. Condensation of similar categories was able to improve interobserver agreement and still maintain stratified risk of malignancy.
The proposed pattern-based risk-stratification scheme, which could be implemented with the forthcoming Milan System, has good overall interobserver agreement and successfully stratifies the risk of malignancy. Some simplification is possible to make the system easier to use and improve interobserver agreement while maintaining stratification of risk. Cancer Cytopathol 2017;125:776-85. © 2017 American Cancer Society.
唾液腺穿刺细胞学检查对患者的术前管理很有用，但仍具有挑战性，因为一些肿瘤广泛的形态学重叠限制了始终确定恶性肿瘤存在的能力。为应对这一挑战，开发基于风险的唾液腺穿刺物分类方案的动力日益增强。在此，作者研究了1种此类模式和基于风险的系统的观察者间变异性。
对来自2个大型学术中心的50份唾液腺穿刺物的选定涂片和细胞块切片进行数字成像。这些扫描玻片由4位细胞病理学家独立、盲法审阅，若观察者认为穿刺物为肿瘤性，则将每个穿刺物归入1个提议的基于模式的类别中。对观察者间一致性进行评分，并对有手术随访结果的病例计算恶性肿瘤的综合风险。
总共42份样本（84%）被至少2位观察者认为是肿瘤性的，并对观察者间一致性进行评分：42份中的10份（23.8%）一致性良好，42份中的14份（33.3%）多数一致，42份中的5份（11.9%）有分歧。42份样本中只有9份（21.4%）一致性最低，42份中的4份（9.5%）无一致性。类似类别的合并能够提高观察者间一致性，同时仍保持恶性肿瘤的分层风险。
提议的基于模式的风险分层方案可与即将推出的米兰系统一起实施，具有良好的总体观察者间一致性，并成功地对恶性肿瘤风险进行了分层。进行一些简化以使该系统更易于使用并提高观察者间一致性，同时保持风险分层是可行的。《癌症细胞病理学》2017年；125：776 - 85。©2017美国癌症协会
