Detlefsen Sönke, Windedal Tobias, Bibeau Frédéric, Bruhn Lærke Valsøe, Carr Norman, Graversen Martin, Markowski Katharina, Mortensen Michael Bau, Neureiter Daniel, Sempoux Christine, Solass Wiebke, Thinesen Malene Theilmann, Fristrup Claus
Department of Pathology, Odense University Hospital, Odense, 5000, Denmark; Odense PIPAC Center (OPC) and Odense Pancreas Center (OPAC), Odense University Hospital, Odense, 5000, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, 5000, Denmark.
Department of Pathology, Odense University Hospital, Odense, 5000, Denmark; Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, 5000, Denmark.
Hum Pathol. 2022 Feb;120:77-87. doi: 10.1016/j.humpath.2021.12.005. Epub 2021 Dec 24.
Pressurized intraperitoneal aerosol chemotherapy (PIPAC)-directed therapy is a new treatment option for peritoneal metastasis (PM). The 4-tiered Peritoneal Regression Grading Score (PRGS) has been proposed for assessment of histological treatment response. We aimed to evaluate the effect of immunohistochemistry (IHC) on interobserver agreement of the PRGS. Hematoxylin and eosin (H&E)-stained and IHC-stained slides (n = 662) from 331 peritoneal quadrant biopsies (QBs) taken prior to 99 PIPAC procedures performed on 33 patients were digitalized and uploaded to a web library. Eight raters (five consultants and three residents) assessed the PRGS, and Krippendorff's alpha coefficients (α) were calculated. Results (IHC-PRGS) were compared with data published in 2019, using H&E-stained slides only (H&E-PRGS). Overall, agreement for IHC-PRGS was substantial to almost perfect. Agreement (all raters) regarding single QBs after treatment was substantial for IHC-PRGS (α = 0.69, 95% confidence interval [CI] = 0.66-0.72) and moderate for H&E-PRGS (α = 0.60, 95% CI = 0.56-0.64). Agreement (all raters) regarding the mean PRGS per QB set after treatment was higher for IHC-PRGS (α = 0.78, 95% CI = 0.73-0.83) than for H&E-PRGS (α = 0.71, 95% CI = 0.64-0.78). Among residents, agreement was almost perfect for IHC-PRGS and substantial for H&E-PRGS. Agreement (all raters) regarding maximum PRGS per QB set after treatment was substantial for IHC-PRGS (α = 0.61, 95% CI = 0.54-0.68) and moderate for H&E-PRGS (α = 0.60, 95% CI = 0.53-0.66). Among residents, agreement was substantial for IHC-PRGS (α = 0.66, 95% CI = 0.57-0.75) and moderate for H&E-PRGS (α = 0.55, 95% CI = 0.45-0.64). Additional IHC seems to improve the interobserver agreement of PRGS, particularly between less experienced raters.
腹腔内加压气溶胶化疗（PIPAC）导向治疗是腹膜转移（PM）的一种新的治疗选择。已提出4级腹膜消退分级评分（PRGS）来评估组织学治疗反应。我们旨在评估免疫组织化学（IHC）对PRGS观察者间一致性的影响。对33例患者进行的99次PIPAC手术前采集的331份腹膜象限活检（QB）的苏木精和伊红（H&E）染色及IHC染色玻片（n = 662）进行数字化处理并上传至网络文库。8名评估者（5名顾问和3名住院医师）对PRGS进行评估，并计算Krippendorff's alpha系数（α）。将结果（IHC-PRGS）与2019年发表的数据进行比较，后者仅使用H&E染色玻片（H&E-PRGS）。总体而言，IHC-PRGS的一致性为实质性到几乎完美。治疗后单个QB的一致性（所有评估者），IHC-PRGS为实质性（α = 0.69，95%置信区间[CI] = 0.66 - 0.72），H&E-PRGS为中等（α = 0.60，95%CI = 0.56 - 0.64）。治疗后每个QB组平均PRGS的一致性（所有评估者），IHC-PRGS高于H&E-PRGS（α = 0.78，95%CI = 0.73 - 0.83）（α = 0.71，95%CI = 0.64 - 0.78）。在住院医师中，IHC-PRGS的一致性几乎完美，H&E-PRGS为实质性。治疗后每个QB组最大PRGS的一致性（所有评估者），IHC-PRGS为实质性（α = 0.61，95%CI = 0.54 - 0.68），H&E-PRGS为中等（α = 0.60，95%CI = 0.53 - 0.66）。在住院医师中，IHC-PRGS的一致性为实质性（α = 0.66，95%CI = 0.57 - 0.75），H&E-PRGS为中等（α = 0.55，95%CI = 0.45 - 0.64）。额外的免疫组织化学似乎可改善PRGS的观察者间一致性，尤其是在经验较少的评估者之间。
