P53 免疫组化在诊断不明确的 Barrett 食管伴异型增生中的应用。

The utility of P53 immunohistochemistry in the diagnosis of Barrett's oesophagus with indefinite for dysplasia.

机构信息

Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK.

Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.

出版信息

Histopathology. 2022 Jun;80(7):1081-1090. doi: 10.1111/his.14642.

AIMS

Barrett's oesophagus with indefinite for dysplasia (BE-IND) is a subjective diagnosis with a low interobserver agreement (IOA) among pathologists and uncertain clinical implications. This study aimed to assess the utility of p53 immunohistochemistry (p53-IHC) in assessing BE-IND specimens.

METHODS AND RESULTS

Archive endoscopic biopsies with a BE-IND diagnosis from two academic centres were analysed. First, haematoxylin and eosin-stained slides (H&E) were reviewed by four expert gastrointestinal (GI) pathologists allocated into two groups (A and B). After a washout period of at least 8 weeks, H&E slides were reassessed side-to-side with p53-IHC available. We compared the rate of changed diagnosis and the IOA for all BE grades before and after p53-IHC. We included 216 BE-IND specimens from 185 patients, 44.0 and 32.9% of which were confirmed after H&E slide revision by groups A and B, respectively. More than half the cases were reclassified to a non-dysplastic BE (NDBE), while 5.6% of cases in group A and 7.4% in group B were reclassified to definite dysplasia. The IOA for NDBE, BE-IND, low-grade dysplasia (LGD) and high-grade dysplasia (HGD)/intramucosal cancer (IMC) was 0.31, 0.21, -0.03 and -0.02, respectively. Use of p53-IHC led to a >40% reduction in BE-IND diagnoses (P < 0.001) and increased IOA for all BE grades [κ = 0.46 (NDBE), 0.26 (BE-IND), 0.49 (LGD), 0.35 (HGD/IMC)]. An aberrant p53-IHC pattern significantly increased the likelihood of reclassifying BE-IND to definite dysplasia (odds ratio = 44.3, 95% confidence interval = 18.8-113.0).

CONCLUSION

P53-IHC reduces the rate of BE-IND diagnoses and improves the IOA among pathologists when reporting BE with equivocal epithelial changes.

目的

巴雷特食管伴不确定异型增生（BE-IND）是一种主观诊断，病理学家之间的观察者间一致性（IOA）较低，且临床意义不确定。本研究旨在评估 p53 免疫组化（p53-IHC）在评估 BE-IND 标本中的作用。

方法和结果

分析了来自两个学术中心的具有 BE-IND 诊断的存档内镜活检。首先，由四位分配到两组（A 和 B）的专家胃肠病学（GI）病理学家对苏木精和伊红染色（H&E）幻灯片进行了回顾。经过至少 8 周的洗脱期后，可用 p53-IHC 对 H&E 幻灯片进行侧对侧评估。我们比较了所有 BE 分级在 p53-IHC 前后改变诊断的比率和 IOA。我们纳入了来自 185 名患者的 216 例 BE-IND 标本，A 组和 B 组分别通过 H&E 幻灯片修订后确认了 44.0%和 32.9%的病例。超过一半的病例被重新分类为非异型增生性 BE（NDBE），而 A 组的 5.6%和 B 组的 7.4%的病例被重新分类为明确异型增生。NDBE、BE-IND、低级别异型增生（LGD）和高级别异型增生（HGD）/黏膜内癌（IMC）的 IOA 分别为 0.31、0.21、-0.03 和-0.02。使用 p53-IHC 导致 BE-IND 诊断减少了>40%（P<0.001），并增加了所有 BE 分级的 IOA[κ=0.46（NDBE）、0.26（BE-IND）、0.49（LGD）、0.35（HGD/IMC）]。异常的 p53-IHC 模式显著增加了将 BE-IND 重新分类为明确异型增生的可能性（比值比=44.3，95%置信区间=18.8-113.0）。