Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Pathology, University of Pittsburgh, Pittsburgh, USA.
Ann Surg Oncol. 2019 Aug;26(8):2607-2614. doi: 10.1245/s10434-019-07447-z. Epub 2019 May 20.
Diagnostic terminology and grading of primary appendiceal mucinous neoplasms lacks uniformity. We sought to identify discordance in pathologic reporting by reviewing pathology slides for cases referred to our institution.
Using guidelines from Peritoneal Surface Oncology Group International (PSOGI) and American Joint Committee on Cancer 8th edition (AJCC8), we compared diagnostic terminology/grading of primary appendiceal mucinous neoplasms (n = 115) between pathology reports from referring institutions and review of slides by pathologists at our high-volume institution.
There was discordance in pathologic terminology and grading of primary appendiceal mucinous neoplasms between referring institutions and our institution in 28% and 50% of patients, respectively. In particular, 24% of patients referred with mucinous adenocarcinoma (MACA) had LAMN on our review, and a higher grade MACA was found in 48% of patients referred with low-grade (G1) MACA and 16% of patients referred with high-grade (G2) MACA following our review. Discordance in tumor grade between primary and metastatic disease was seen in 19% of cases based on referred primary tumor grading compared with only 4% following our review. Systemic chemotherapy was unnecessarily administered to four cases of LAMN (6%) and inappropriately not administered to four cases of MACA (6%) before referral due to inaccurate diagnosis/grading by referring institutions.
We found significant discordance in diagnostic terminology/grading of primary appendiceal mucinous neoplasms following review of referred cases. Inaccurate pathologic assessment was associated with overtreatment or undertreatment with chemotherapy. These data highlight the need for pathologic review of such rare cases at high-volume centers.
原发性阑尾黏液性肿瘤的诊断术语和分级缺乏一致性。我们通过查阅我院转来的病例病理切片，试图发现病理报告中的不一致。
我们使用腹膜表面肿瘤国际组织（PSOGI）和美国癌症联合委员会第 8 版（AJCC8）的指南，比较了我院高容量机构病理医生对转诊机构病理报告中原发性阑尾黏液性肿瘤（n=115）的诊断术语/分级。
在转诊机构和我院，原发性阑尾黏液性肿瘤的病理术语和分级分别有 28%和 50%的患者存在不一致。特别是，24%的转诊患者被诊断为黏液性腺癌（MACA），但在我院复查时发现其中 24%为低级别阑尾黏液性肿瘤（LAMN）；48%的低级别 MACA 患者和 16%的高级别 MACA 患者在我院复查时被诊断为高级别 MACA。在根据转诊原发性肿瘤分级的情况下，19%的病例中观察到原发和转移疾病的肿瘤分级不一致，而在我院复查后仅为 4%。由于转诊机构的诊断/分级不准确，导致 4 例 LAMN（6%）患者不必要地接受了全身化疗，4 例 MACA（6%）患者未接受适当的化疗。
我们发现，在查阅转诊病例后，原发性阑尾黏液性肿瘤的诊断术语/分级存在显著差异。不准确的病理评估与化疗的过度或不足治疗有关。这些数据强调了在高容量中心对这些罕见病例进行病理复查的必要性。
