Overinterpretation is common in pathological diagnosis of appendix cancer during patient referral for oncologic care
| Autor: | Alexey Hodkoff, Grace Y. Lin, Mark A. Valasek, Andrew M. Lowy, Vera Vavinskaya, Kaitlyn J. Kelly, Irene Thung, Esha Gollapalle, Joel M. Baumgartner, Mojgan Hosseini, Ann Tipps |
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| Přispěvatelé: | Robboy, Stanley J |
| Rok vydání: | 2016 |
| Předmět: |
Male
lcsh:Medicine Biochemistry Epithelium 0302 clinical medicine Adenocarcinomas Neoplasms 80 and over Medicine and Health Sciences Pseudomyxoma peritonei Mucinous lcsh:Science Referral and Consultation Cancer Aged 80 and over screening and diagnosis Multidisciplinary Anatomical pathology Middle Aged Adenocarcinoma Mucinous Adenomas Appendix Detection medicine.anatomical_structure Appendiceal Neoplasms Oncology 030220 oncology & carcinogenesis Adenocarcinoma 030211 gastroenterology & hepatology Female Radiology Patient Safety Anatomy Research Article Adult medicine.medical_specialty Histology General Science & Technology and over Carcinomas 03 medical and health sciences Diagnostic Medicine medicine Cancer Detection and Diagnosis Humans Mucocele Pathological Aged Gynecology Neoplasm Grading business.industry Prevention lcsh:R Cancers and Neoplasms Biology and Life Sciences Proteins medicine.disease Pseudomyxoma Peritonei 4.1 Discovery and preclinical testing of markers and technologies Biological Tissue Mucin Appendix cancer lcsh:Q business Clinical Laboratory Information Systems |
| Zdroj: | PLoS ONE PloS one, vol 12, iss 6 PLoS ONE, Vol 12, Iss 6, p e0179216 (2017) |
| ISSN: | 1932-6203 |
| Popis: | Author(s): Valasek, Mark A; Thung, Irene; Gollapalle, Esha; Hodkoff, Alexey A; Kelly, Kaitlyn J; Baumgartner, Joel M; Vavinskaya, Vera; Lin, Grace Y; Tipps, Ann P; Hosseini, Mojgan V; Lowy, Andrew M | Abstract: ContextLow-grade appendiceal mucinous neoplasm (LAMN) and appendiceal adenocarcinoma are known to cause the majority of pseudomyxoma peritonei (PMP, i.e. mucinous ascites); however, recognition and proper classification of these neoplasms can be difficult despite established diagnostic criteria.ObjectiveTo determine the pathological diagnostic concordance for appendix neoplasia and related lesions during patient referral to an academic medical center specialized in treating patients with PMP.DesignThe anatomic pathology laboratory information system was searched to identify cases over a two-year period containing appendix specimens with mucinous neoplasia evaluated by an outside pathology group and by in-house slide review at a single large academic medical center during patient referral.Results161 cases containing appendix specimens were identified over this period. Forty-six of 161 cases (28.6%) contained appendiceal primary neoplasia or lesions. Of these, the originating pathologist diagnosed 23 cases (50%) as adenocarcinoma and 23 cases (50%) as LAMN; however, the reference pathologist diagnosed 29 cases (63.0%) as LAMN, 13 cases (28.3%) as adenocarcinoma, and 4 cases (8.7%) as ruptured simple mucocele. Importantly, for cases in which the originating pathologist rendered a diagnosis of adenocarcinoma, the reference pathologist rendered a diagnosis of adenocarcinoma (56.5%, 13 of 23), LAMN (39.1%, 9 of 23), or simple mucocele (4.3%, 1 of 23). The overall diagnostic concordance rate for these major classifications was 71.7% (33 of 46) with an unweighted observed kappa value of 0.48 (95% CI, 0.27-0.69), consistent with moderate interobserver agreement. All of the observed discordance (28.3%) for major classifications could be attributed to over-interpretation. In addition, the majority of LAMN cases (65.5%) had potential diagnostic deficiencies including over-interpretation as adenocarcinoma and lacking or discordant risk stratification (i.e. documentation of extra-appendiceal neoplastic epithelium).ConclusionsAppendiceal mucinous lesions remain a difficult area for appropriate pathological classification with substantial discordance due to over-interpretation in this study. The findings highlight the critical need for recognition and application of diagnostic criteria regarding these tumors. Recently published consensus guidelines and a checklist provided herein may help facilitate improvement of diagnostic concordance and thereby reduce over-interpretation and potential overtreatment. Further studies are needed to determine the extent of this phenomenon and its potential clinical impact. |
| Databáze: | OpenAIRE |
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