Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, L2, 44195, Cleveland, Ohio, USA.
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Head Neck Pathol. 2022 Dec;16(4):963-968. doi: 10.1007/s12105-022-01439-4. Epub 2022 Apr 30.
Depth of invasion (DOI) was added to the staging criteria for carcinoma of the lip and oral cavity in the 8th edition of the American Joint Committee on Cancer Staging Manual (AJCC8). However, there are multiple practical challenges to obtaining an accurate DOI measurement with limited data regarding interobserver variability in DOI measurement. The aim of this study was to investigate interobserver variability in DOI measurement and its effect on tumor stage. We performed an electronic medical record search for excisions of squamous cell carcinoma of the oral cavity between January 1, 2010 and December 25, 2017. All slides containing significant tumor were selected for independent blinded DOI measurement by four head and neck pathologists per AJCC8 guidelines. Pathologic stage was assigned in conjunction with reported tumor greatest dimension. Observers recorded the slide used for measurement and potential issues limiting assessment of DOI. Results were compared for reproducibility in DOI and tumor stage using intraclass correlation coefficient (ICC) analysis. A total of 167 cases of oral squamous cell carcinoma with available slides were included. The ICC score for DOI between observers was 0.91339 (> 0.9 considered excellent). Only 7.2% of cases had uniform DOI amongst observers. Increasing overall tumor size and average DOI correlated with increasing range in DOI amongst observers. Differences in DOI resulted in differences in pathologic tumor staging (pT) for 15% of tumors. Use of different slides for DOI measurements was significantly associated with different pT staging. In contrast, ulceration and exophytic growth did not correlate with higher DOI or pT variability. Despite the excellent ICC score, differences in DOI measurement resulted in variable pT staging for a considerable number of cases. We therefore recommend consensus for DOI in at least some cases in which potential differences in DOI could alter pT stage assignment.
深度侵犯（DOI）已被添加到第 8 版美国癌症联合委员会癌症分期手册（AJCC8）的唇癌和口腔癌分期标准中。然而，由于在 DOI 测量方面缺乏观察者间变异性的有限数据，因此获取准确的 DOI 测量值存在多种实际挑战。本研究旨在调查 DOI 测量的观察者间变异性及其对肿瘤分期的影响。我们对 2010 年 1 月 1 日至 2017 年 12 月 25 日期间切除的口腔鳞状细胞癌的电子病历进行了搜索。根据 AJCC8 指南，每位头颈部病理学家选择包含显著肿瘤的所有切片进行独立盲法 DOI 测量。病理分期与报告的肿瘤最大直径相结合。观察者记录用于测量的切片以及可能限制 DOI 评估的潜在问题。使用组内相关系数（ICC）分析比较 DOI 和肿瘤分期的重现性。共纳入 167 例有可用切片的口腔鳞状细胞癌病例。观察者之间 DOI 的 ICC 评分为 0.91339（>0.9 认为优秀）。只有 7.2%的病例在观察者之间具有统一的 DOI。总体肿瘤大小和平均 DOI 的增加与观察者之间 DOI 范围的增加相关。DOI 的差异导致 15%的肿瘤在病理肿瘤分期（pT）方面存在差异。DOI 测量使用不同的切片与不同的 pT 分期显著相关。相比之下，溃疡和外生性生长与更高的 DOI 或 pT 变异性无关。尽管 ICC 评分很高，但 DOI 测量的差异导致相当多的病例出现不同的 pT 分期。因此，我们建议在至少某些可能改变 pT 分期的 DOI 差异的情况下，对 DOI 达成共识。
