Carroll Jesse, Day Tania, Allbritton Jill, Ghioni Mariacristina, Heller Debra, Newman Marsali, Preti Eleonora Petra, Preti Mario, Selim Maria Angelica, Skala Stephanie L, Smith Deborah, Tota Daniele, van der Griend Rachael, Scurry James
Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia.
University of Maryland, Columbia, MD.
J Low Genit Tract Dis. 2025 Sep 2;29(4):304-9. doi: 10.1097/LGT.0000000000000909.
Depth of invasion (DOI) in vulvar squamous cell carcinoma (vSCC) predicts risk of nodal metastasis, with measurement >1 mm dictating the need for lymph node diagnostic procedures. In 2021, the International Federation of Gynecology and Obstetrics (FIGO) changed its advice on how pathologists measure DOI. Some organizations revised guidelines to this "New" method; others continued to endorse the FIGO 2009 "Old" method. This study compares interobserver variation of vSCC DOI using Old and New FIGO measurement strategies.
A single representative image was chosen from 50 consecutive vSCC excisions with reported DOI of 0.1-3 mm. Ten pathologists provided 2 electronic measurements for each, using Old and New methods. Statistical evaluation included analyses of variance, Student t -test, and the kappa statistic.
The Old method yielded a larger mean DOI than the New [1.3 vs 0.9 mm; p < .001]. The Old method had a lower proportion of measurement disagreements spanning 1 mm (53%, κ = 0.65% vs 68%, κ = 0.6). Agreement by all pathologists of DOI being either ≤1 mm or >1 mm occurred in 29/50 cases (58%) using the Old and 26 (52%) using the New method. When at least 2 pathologists measured DOI >1 mm, interobserver variation was lower using the Old method in 30 (83%) of 36 cases [mean difference = -0.1 mm, t (280) = -2.78, p = .008].
The FIGO 2021 DOI measurement method has higher interobserver variation than FIGO 2009, with this difference arising from tumors with DOI >1 mm. This finding, combined with inadequate international consensus and scant clinical outcome data, should trigger reconsideration of 2021 FIGO staging guidelines.
外阴鳞状细胞癌（vSCC）的浸润深度（DOI）可预测淋巴结转移风险，测量值>1mm表明需要进行淋巴结诊断程序。2021年，国际妇产科联合会（FIGO）改变了其关于病理学家如何测量DOI的建议。一些组织将指南修订为这种“新”方法；其他组织则继续支持FIGO 2009年的“旧”方法。本研究比较了使用FIGO旧测量策略和新测量策略时vSCC DOI的观察者间差异。
从50例连续的vSCC切除术中选择一张代表性图像，报告的DOI为0.1 - 3mm。10名病理学家分别使用旧方法和新方法对每张图像进行2次电子测量。统计评估包括方差分析、学生t检验和kappa统计量。
旧方法得出的平均DOI大于新方法[1.3 vs 0.9mm；p <.001]。旧方法跨越1mm的测量分歧比例较低（53%，κ = 0.65% vs 68%，κ = 0.6）。使用旧方法时，50例中有29例（58%）、使用新方法时50例中有26例（52%）的DOI得到所有病理学家一致认为≤1mm或>1mm。当至少2名病理学家测量的DOI>1mm时，36例中有30例（83%）使用旧方法时观察者间差异更低[平均差异=-0.1mm，t(280)= -2.78，p =.008]。
FIGO 2021年的DOI测量方法比FIGO 2009年具有更高的观察者间差异，这种差异源于DOI>1mm的肿瘤。这一发现，再加上国际上缺乏共识以及临床结局数据不足，应促使重新考虑2021年FIGO分期指南。
