Department of Volunteer Services, University of Texas Southwestern Medical Center, Dallas, TX, USA.
California Institute of Technology, Pasadena, CA, USA.
Am J Clin Pathol. 2021 Aug 4;156(3):356-369. doi: 10.1093/ajcp/aqaa240.
We investigated the accuracy of clinical breast carcinoma anatomic staging and the greatest tumor dimension measurements.
We compared clinical stage and greatest dimension values with the pathologic reference standard values using 57,747 cases from the 2016 US National Cancer Institute Surveillance, Epidemiology, and End Results program who were treated by surgical resection without prior neoadjuvant therapy.
Agreement for clinical vs pathologic anatomic TNM group stage, overall, is 74.3% ± 0.4%. Lymph node N staging overall agrees very well (85.1% ± 0.4%). Based on tumor dimension and location, T staging has an agreement of only 64.2% ± 0.4%, worsening to 55% without carcinoma in situ (Tis) cases. In approximately 25% of cases, pathologic T stage is higher than clinical T stage. The mean difference in the greatest dimension is 1.36 ± 9.59 mm with pathologic values being generally larger than clinical values; pathologic and clinical measurements correlate well. T-stage disagreement is associated with histology, tumor grade, tumor size, N stage, patient age, periodic biases in tumor size measurements, and overuse of family T-stage categories. Pathologic measurement biases include rounding and specimen-slicing intervals.
Clinical and pathologic T-staging values agree only moderately. Pathologists face challenges in increasing the precision of gross tumor measurements, with the goal of improving the accuracy of clinical T staging and measurement.
我们研究了临床乳腺癌解剖分期和最大肿瘤尺寸测量的准确性。
我们比较了 57747 例未接受新辅助治疗且接受手术切除治疗的 2016 年美国国家癌症研究所监测、流行病学和最终结果计划患者的临床分期和最大尺寸值与病理参考标准值。
临床与病理解剖 TNM 组分期总体上的一致性为 74.3%±0.4%。淋巴结 N 分期总体上非常一致（85.1%±0.4%）。基于肿瘤尺寸和位置，T 分期的一致性仅为 64.2%±0.4%，无原位癌（Tis）病例时降至 55%。大约 25%的病例中，病理 T 期高于临床 T 期。最大尺寸的平均差值为 1.36±9.59mm，病理值通常大于临床值；病理和临床测量相关性良好。T 分期不一致与组织学、肿瘤分级、肿瘤大小、N 分期、患者年龄、肿瘤大小测量的周期性偏差以及过度使用家族 T 分期类别有关。病理测量偏差包括舍入和标本切片间隔。
临床和病理 T 分期值仅中度一致。病理学家面临着提高大体肿瘤测量精度的挑战，目标是提高临床 T 分期和测量的准确性。
