Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Harvard Medical School, Boston, MA, USA.
Endocr Pathol. 2022 Sep;33(3):371-377. doi: 10.1007/s12022-022-09718-0. Epub 2022 May 13.
Grade, based on proliferative activity and tumor necrosis, has recently been shown to be prognostic in medullary thyroid carcinoma (MTC) in multivariate analysis. The aim of this study was to evaluate the interobserver reproducibility of assessed grade in MTC. Three groups (each group included one resident/fellow and one attending pathologist) independently evaluated a cohort of 44 sporadic MTC. For each case, all available tumor slides were reviewed, and mitotic count and the presence of tumor necrosis were recorded. Ki-67 was performed, and the Ki-67 proliferative index was determined in the area of highest proliferative activity. Tumors were graded according to the recently published International Medullary Thyroid Carcinoma Grading System (IMTCGS). Kappa statistics were calculated for each individual criterion (mitotic count, Ki-67 proliferative index, and necrosis) and for assigned IMTCGS grade. For our cohort of 44 MTCs, the kappa statistic for mitotic count, Ki-67 proliferative index, and necrosis was 0.68, 0.86, and 0.89, respectively. The kappa statistic for assigned IMTCGS grade was 0.87. Our findings indicate that there was a strong level of agreement for assessment of grade in our cohort of MTC, indicating that grade as assessed by the IMTCGS is not only prognostic but also reproducible.
在多变量分析中，最近发现分级（基于增殖活性和肿瘤坏死）在甲状腺髓样癌（MTC）中具有预后意义。本研究的目的是评估 MTC 中评估分级的观察者间可重复性。三个小组（每个小组包括一名住院医师/研究员和一名主治病理学家）独立评估了 44 例散发性 MTC 队列。对于每个病例，都回顾了所有可用的肿瘤切片，并记录了有丝分裂计数和肿瘤坏死的存在。进行了 Ki-67 检测，并在增殖活性最高的区域确定了 Ki-67 增殖指数。根据最近发表的国际甲状腺髓样癌分级系统（IMTCGS）对肿瘤进行分级。为每个单独的标准（有丝分裂计数、Ki-67 增殖指数和坏死）和分配的 IMTCGS 分级计算了 Kappa 统计量。对于我们的 44 例 MTC 队列，有丝分裂计数、Ki-67 增殖指数和坏死的 Kappa 统计量分别为 0.68、0.86 和 0.89。分配的 IMTCGS 分级的 Kappa 统计量为 0.87。我们的发现表明，在我们的 MTC 队列中，对分级的评估存在很强的一致性，这表明 IMTCGS 评估的分级不仅具有预后意义，而且具有可重复性。
