Department of Head and Neck Surgery and Oncology at the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, the Netherlands.
Department of Head and Neck Surgery and Oncology at the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, NL-1066 CX Amsterdam, the Netherlands.
Eur J Surg Oncol. 2019 Feb;45(2):235-241. doi: 10.1016/j.ejso.2018.10.529. Epub 2018 Oct 25.
TNM staging of melanoma has recently been altered by the introduction of the 8th edition of the AJCC Cancer Staging manual. The purpose of this study is to analyze the inter-observer variation of histopathology reports and its effect on recommended treatment policy.
We retrospectively analyzed 296 cases, diagnosed as primary cutaneous head and neck melanoma (2005-2016), referred to the Netherlands Cancer Institute (NCI) for treatment after prior diagnosis in another hospital (non-NCI). All reports were analyzed for patients demographics, tumor characteristics and histopathologic features.
In 53% and 40% of the cases, the histopathologic parameters were discordant, according to AJCC 7th and 8th edition, respectively. This indicated a perfect inter-observer agreement for the measurement of Breslow thickness (Intraclass correlation coefficient (ICC) = 0.981) and a substantial agreement for subtype (kappa statistic (κ) = 0.648) and ulceration (κ = 0.802), while only moderate for dermal mitotic activity (κ = 0.472). After NCI review, recommended treatment policies were changed in 13% and 11% of the patients when applying TNM 7 and TNM 8, respectively. Scheduling sentinel lymph node biopsy (SLNB) changed in 14 (5%) and 10 (3%) cases when using TNM 7 and TNM 8, respectively.
Review by a NCI pathologist of histopathologic parameters of primary cutaneous head and neck melanoma led to significant changes in treatment decision. Introduction of the AJCC 8th edition led to slightly less discordances between NCI and non-NCI reports and consequently smaller impact on treatment planning. Expert review remains indicated when a SLNB is considered for additional staging in selected cases.
最近，随着第 8 版 AJCC 癌症分期手册的引入，黑色素瘤的 TNM 分期发生了变化。本研究的目的是分析组织病理学报告的观察者间变异及其对推荐治疗方案的影响。
我们回顾性分析了 296 例被诊断为原发性头颈部皮肤黑色素瘤（2005-2016 年）的患者，这些患者在另一家医院诊断后，转诊至荷兰癌症研究所（NCI）进行治疗（非 NCI）。所有报告均分析了患者的人口统计学特征、肿瘤特征和组织病理学特征。
根据 AJCC 第 7 版和第 8 版，分别有 53%和 40%的病例组织病理学参数不一致，这表明 Breslow 厚度的测量具有完美的观察者间一致性（组内相关系数（ICC）=0.981），并且对于亚型（kappa 统计量（κ）=0.648）和溃疡（κ=0.802）具有实质性一致性，而对于真皮有丝分裂活性仅有中度一致性（κ=0.472）。在 NCI 审查后，当应用 TNM 7 时，13%的患者和应用 TNM 8 时，11%的患者的治疗方案发生了变化。当应用 TNM 7 和 TNM 8 时，分别有 14 例（5%）和 10 例（3%）患者的前哨淋巴结活检（SLNB）计划发生了变化。
NCI 病理学家对原发性头颈部皮肤黑色素瘤组织病理学参数的审查导致治疗决策发生了重大变化。第 8 版 AJCC 的引入导致 NCI 和非 NCI 报告之间的差异略有减少，因此对治疗计划的影响也较小。在某些情况下，当考虑进行 SLNB 以进行额外分期时，仍需要专家审查。
