Department of Pathology (M.E.P., N.P.R., R.L.G., M.R.K.) Department of Obstetrics and Gynecology, Division of Gynecologic Oncology (K.A., B.M.N., K.P., E.M.S), University of Washington Department of Pathology, Virginia Mason Hospital and Medical Center (S.N.A.), Seattle, Washington.
Int J Gynecol Pathol. 2020 May;39(3):261-269. doi: 10.1097/PGP.0000000000000604.
Intraepithelial fallopian tube neoplasia is thought to be a precursor lesion to high-grade serous carcinoma of the Müllerian adnexae, particularly in women with BRCA1 or BRCA2 mutations. This association has led to recommendations to assess fallopian tubes for intraepithelial atypia. However, the diagnostic reproducibility of a diagnosis of intraepithelial neoplasia is unclear. In this study, 2 gynecologic pathologists independently evaluated sections of fallopian tubes from a sample of women (N=198, 623 slides) undergoing salpingectomy. A total of 101 (54%) women were undergoing risk-reducing salpingo-oophorectomy. Pathologists were blinded to patient histories and prior diagnoses. Pathologists rendered one of three diagnoses for each slide: "negative for fallopian tube intraepithelial neoplasia (FTIN)," "indeterminate for FTIN," or "definite for FTIN." Cases that were considered by histology definite for FTIN or suspicious for FTIN were stained with p53 and Ki67. Pathologists agreed on the diagnosis of "definite for FTIN" 61.5% of the time. There was no agreement on any cases for the diagnosis of "indeterminate for FTIN." Fifteen "indeterminate for FTIN" and 12 "definite for FTIN" cases were stained with p53 and Ki67. Two of the "indeterminate" cases (13%) had p53-positive foci. Five of the "definite" cases had p53-positive foci. In 3 of the other 8 "definite" cases, there was obvious carcinoma present, but the carcinoma did not stain with p53, suggesting a possible null phenotype. We propose that immunostains should only be used to aid in the diagnosis of FTIN in cases with indeterminate histology. The use of p53 immunohistochemistry in cases that were considered "definite for FTIN" by histology was minimally helpful, and in fact often served to further confuse the diagnosis.
输卵管上皮内肿瘤被认为是输卵管上皮内异型增生的高级别浆液性卵巢癌的前驱病变，尤其是在 BRCA1 或 BRCA2 突变的女性中。这种关联导致建议评估输卵管上皮内异型增生。然而，输卵管上皮内肿瘤的诊断重复性尚不清楚。在这项研究中，两名妇科病理学家独立评估了接受输卵管切除术的一组女性（N=198，623 张切片）的输卵管切片。共有 101 名（54%）女性正在接受降低风险的输卵管卵巢切除术。病理学家对患者病史和先前诊断均不知情。病理学家对每张切片做出以下三种诊断之一：“输卵管上皮内肿瘤阴性（FTIN）”、“FTIN 不确定”或“FTIN 明确”。被组织学认为是 FTIN 明确或可疑的病例用 p53 和 Ki67 染色。病理学家对“FTIN 明确”的诊断有 61.5%的时间达成一致。对任何“FTIN 不确定”的诊断均未达成一致。15 例“FTIN 不确定”和 12 例“FTIN 明确”的病例用 p53 和 Ki67 染色。2 例“不确定”病例（13%）有 p53 阳性灶。5 例“明确”病例有 p53 阳性灶。在其他 8 例“明确”病例中的 3 例，有明显的癌存在，但癌未与 p53 染色，提示可能存在无表型。我们建议仅在组织学上不确定的病例中使用免疫组化来辅助 FTIN 的诊断。在组织学上被认为“FTIN 明确”的病例中使用 p53 免疫组化几乎没有帮助，实际上常常使诊断更加困惑。
