Interobserver Diagnostic Concordance of Serous Tubal Intraepithelial Carcinoma and Related Lesions.
Russell Vang, Kala Visvanathan, Vinita Parkash, Patricia Shaw, Ie-Ming Shih, Amy Gross, Robert Soslow, Robert Kurman. Johns Hopkins School of Medicine, Baltimore, MD; Yale University School of Medicine, New Haven, CT; University Health Network University of Toronto, ON, Canada; Memorial Sloan-Kettering Cancer Center, New York, NY
Background: Serous tubal intraepithelial carcinoma (STIC) is a candidate precursor to pelvic high grade serous carcinoma (HGSC). There also exists a spectrum of lesions that are putative STIC precursors, namely “p53 signature,” which lacks nuclear atypia, and tubal intraepithelial lesion in transition (TILT), which exhibits atypia, but falls short of STIC. A recent study (Carlson, et al.) reported suboptimal interobserver concordance when morphologic guidelines, but not immunohistochemistry (IHC), were used for categorization. The current study tested an algorithm to enhance interobserver concordance, with the ultimate goal of developing a classification scheme that can be used for diagnostic standardization.
Design: Empirically derived morphologic criteria were tested using a panel of 6 pathologists who independently examined 67 lesions in round 1. An around-the-scope training session and IHC (using p53 and Ki-67) were added to morphologic examination, followed by independent assessment of 42 cases in round 2.
Results: From round 1 to 2, kappa values improved from 0.3 to 0.5 for normal/reactive lesions, from 0.1 to 0.35 for atypical/p53 signature/STIL [akin to TILT], and from 0.4 to 0.78 for STIC.
Conclusions: Substantial concordance was achieved for categorizing STIC using a combination of morphologic assessment and IHC. Further work is required to optimize reproducibility for lesions falling short of STIC.
Category: Gynecologic & Obstetrics
Tuesday, March 1, 2011 9:00 AM
Platform Session: Section D, Tuesday Morning