Histological interpretation of differentiated vulvar intraepithelial neoplasia (dVIN) remains challenging-observations from a bi-national ring-study.

Autor: Dasgupta S; Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands. s.dasgupta@erasmusmc.nl., de Jonge E; Department of Pathology, Groene Hart Ziekenhuis, Gouda, The Netherlands., Van Bockstal MR; Department of Pathology, Cliniques Universitaires Saint-Luc Bruxelles, Brussels, Belgium., Wong-Alcala LSM; Department of Pathology, Pathologisch en Cytologisch laboratorium, Breda, The Netherlands., Wilhelmus S; Department of Pathology, Pathan B.V., Laboratory for Pathology, Rotterdam, The Netherlands., Makkus LACF; Laboratory for Pathology, PAL Dordrecht, Dordrecht, The Netherlands., Schelfout K; Department of Pathology, Bravis Ziekenhuis, Bergen op Zoom, The Netherlands.; Department of Pathology, Ziekenhuis Geel, Geel, Belgium., Van de Vijver KK; Department of Pathology, Cancer Research Institute Ghent, Ghent University Hospital, Ghent, Belgium.; Department of Pathology, Antwerp University, Antwerp, Belgium., Smits S; Department of Pathology, Pathan B.V., Laboratory for Pathology, Rotterdam, The Netherlands., Marbaix E; Department of Pathology, Cliniques Universitaires Saint-Luc Bruxelles, Brussels, Belgium., Koljenović S; Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands., van Kemenade FJ; Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands., Ewing-Graham PC; Department of Pathology, Erasmus MC, University Medical Centre, Postbus 2040, Be-building, 3000CA, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Virchows Archiv : an international journal of pathology [Virchows Arch] 2021 Aug; Vol. 479 (2), pp. 305-315. Date of Electronic Publication: 2021 Mar 08.
DOI: 10.1007/s00428-021-03070-0
Abstrakt: Differentiated vulvar intraepithelial neoplasia (dVIN) is a premalignant lesion that is known to progress rapidly to invasive carcinoma. Accurate histological diagnosis is therefore crucial to allow appropriate treatment. To identify reliable diagnostic features, we evaluated the inter-observer agreement in the histological assessment of dVIN, among a bi-national, multi-institutional group of pathologists. Two investigators from Erasmus MC selected 36 hematoxylin-eosin-stained glass slides of dVIN and no-dysplasia, and prepared a list of 15 histological features of dVIN. Nine participating pathologists (i) diagnosed each slide as dVIN or no-dysplasia, (ii) indicated which features they used for the diagnosis, and (iii) rated these features in terms of their diagnostic usefulness. Diagnoses rendered by > 50% participants were taken as the consensus (gold standard). p53-immunohistochemistry (IHC) was performed for all cases, and the expression patterns were correlated with the consensus diagnoses. Kappa (ĸ)-statistics were computed to measure inter-observer agreements, and concordance of the p53-IHC patterns with the consensus diagnoses. For the diagnosis of dVIN, overall agreement was moderate (ĸ = 0.42), and pair-wise agreements ranged from slight (ĸ = 0.10) to substantial (ĸ = 0.73). Based on the levels of agreement and ratings of usefulness, the most helpful diagnostic features were parakeratosis, cobblestone appearance, chromatin abnormality, angulated nuclei, atypia discernable under × 100, and altered cellular alignment. p53-IHC patterns showed substantial concordance (ĸ = 0.67) with the consensus diagnoses. Histological interpretation of dVIN remains challenging with suboptimal inter-observer agreement. We identified the histological features that may facilitate the diagnosis of dVIN. For cases with a histological suspicion of dVIN, consensus-based pathological evaluation may improve the reliability of the diagnosis.
(© 2021. The Author(s).)
Databáze: MEDLINE
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