Jung Ho Jin, Lee Soo Yeon, Hong Jin Hwa, Chun Yi Kyeong
Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
J Pathol Transl Med. 2021 Jan;55(1):43-52. doi: 10.4132/jptm.2020.10.04. Epub 2020 Dec 3.
The accurate pathologic diagnosis and subtyping of high-grade endometrial carcinoma are often problematic, due to its atypical and overlapping histopathological features.
Three pathologists reviewed 21 surgically resected cases of advancedstage endometrial carcinoma. The primary diagnosis was based only on hematoxylin and eosin stained slides. When a discrepancy arose, a secondary diagnosis was made by additional review of immunohistochemical (IHC) stains. Finally, three pathologists discussed all cases and rendered a consensus diagnosis.
The primary diagnoses were identical in 13/21 cases (62%). The secondary diagnosis based on the addition of IHC results was concordant in four of eight discrepant cases. Among four cases with discrepancies occurring in this step, two cases subsequently reached a consensus diagnosis after a thorough discussion between three reviewers. Next-generation sequencing (NGS) study was performed in two cases in which it was difficult to distinguish between serous carcinoma and endometrioid carcinoma. Based on the sequencing results, a final diagnosis of serous carcinoma was rendered. The overall kappa for concordance between the original and consensus diagnosis was 0.566 (moderate agreement).
We investigated stepwise changes in interobserver diagnostic reproducibility in advanced-stage endometrial carcinoma. We demonstrated the utility of IHC and NGS study results in the histopathological diagnosis of advanced-stage endometrial carcinoma.
由于高级别子宫内膜癌具有非典型和重叠的组织病理学特征，其准确的病理诊断和亚型分类常常存在问题。
三位病理学家对21例手术切除的晚期子宫内膜癌病例进行了回顾。初步诊断仅基于苏木精和伊红染色切片。当出现分歧时，通过额外审查免疫组织化学（IHC）染色进行二次诊断。最后，三位病理学家讨论了所有病例并给出了一致诊断。
13/21例（62%）的初步诊断相同。基于IHC结果的二次诊断在8例有分歧的病例中有4例一致。在这一步出现分歧的4例病例中，有2例在三位审阅者进行深入讨论后最终达成了一致诊断。对2例难以区分浆液性癌和子宫内膜样癌的病例进行了二代测序（NGS）研究。根据测序结果，最终诊断为浆液性癌。原始诊断与一致诊断之间的总体一致性kappa为0.566（中度一致）。
我们研究了晚期子宫内膜癌观察者间诊断可重复性的逐步变化。我们证明了IHC和NGS研究结果在晚期子宫内膜癌组织病理学诊断中的实用性。
