Diagnostic Reproducibility of Gastric-Type Endocervical Mucinous Adenocarcinoma: Validation of the Novel Diagnostic Criteria
F Kawakami, Y Mikami, A Kojima, R Nishimura, T Manabe. Kyoto University Hospital, Kyoto, Japan; Ehime University Graduate School of Medical Science, Toon, Ehime, Japan; Hyogo Cancer Center, Akashi, Hyogo, Japan
Background: Gastric-type endocervical adenocarcinoma is considered to be a distinct entity, which can be recognized based on morphology using the novel criteria as established by Kojima and Mikami et al. Because of its aggressive clinical course, it may be meaningful to detect the gastric-type adenocarcinoma and alert attending gynecologists for optimal management. This study aims to examine validity of the novel criteria.
Design: We selected 30 cases of endocervical adenocarcinoma, including gastric-type (n=15), usual-type (n=10), intestinal-type (n=2), endometrioid-type (n=1), clear cell-type (n=1), and serous-type (n=1), and prepared 1 to 6 electronic images to show representative features in each case. The gastric-type was defined as (1)mucinous adenocarcinoma with (2) abundant clear and/or pale eosinophilic cytoplasm, and (3) distinct cell border. In addition, a PowerPoint file was produced to understand the criteria, illustrating morphologic characteristics of the gastric-type. The image and instruction files were recorded on CD and mailed to 33 diagnostic pathologists. After the instruction, the attendees reviewed the images and divided cases into two categories, i.e., gastric-type and non-gastric-type. Non-gastric-type was further classified. The agreement with consensus diagnosis was estimated using kappa statistics.
Results: Regarding gastric vs non-gastric-type, the mean kappa value among reviewers was 0.66 (range: 0.33-0.93). There was no significant difference in rate of agreement with consensus diagnosis between usual- and gastric-type (65.0% vs 66.0%). The distribution of kappa was bimodal. The degree of agreement was correlated with neither experience after board certification nor subspecialty. Some cases of gastric-type were poorly recognized because cytoplasm was scant, and/or cells with clear cytoplasm resembled goblet cells.
Incidence of agreement with consensus diagnosis in each case
|Histological type||Case #||Mean (%)||Range (%)|
Conclusions: The novel criteria for the gastric-type endocervical adenocarcinoma appears valid, and well-illustrated instruction is contributory for good reproducibility for the diagnosis.
Monday, March 9, 2009 1:00 PM
Poster Session II # 144, Monday Afternoon