Diagnosing colorectal medullary carcinoma: interobserver variability and clinicopathological implications
| Autor: | Martin R. Weiser, Sinisa Ivelja, Mithat Gonen, Lik Hang Lee, Bing Ren, Rhonda K. Yantiss, Be Huynh, Hamza Guend, Jinru Shia, Zsofia K. Stadler, Marcela Santos Calvacanti, Jaclyn F. Hechtman, Yue Xue, Eran Sadot, David S. Klimstra, Efsevia Vakiani, Tatiana Shitilbans |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Adult Male Pathology medicine.medical_specialty Medullary cavity Colorectal cancer Biopsy DNA Mismatch Repair Article Pathology and Forensic Medicine 03 medical and health sciences Young Adult 0302 clinical medicine Predictive Value of Tests Terminology as Topic medicine Biomarkers Tumor Humans Aged Aged 80 and over Observer Variation Colorectal Medullary Carcinoma business.industry Microsatellite instability Reproducibility of Results Cell Differentiation Middle Aged medicine.disease Prognosis Immunohistochemistry Confidence interval 030104 developmental biology DNA Repair Enzymes Medullary carcinoma 030220 oncology & carcinogenesis Carcinoma Medullary Cohort Female business Indeterminate Colorectal Neoplasms |
| Popis: | Colorectal medullary carcinoma, recognized by the World Health Organization as a distinct histologic subtype, is commonly regarded as a specific entity with an improved prognosis and unique molecular pathogenesis. A fundamental but as yet unaddressed question, however, is whether it can be diagnosed reproducibly. In this study, by analyzing 80 colorectal adenocarcinomas whose dominant growth pattern was solid (thus encompassing medullary carcinoma and its mimics), we provided a detailed description of the morphological spectrum from "classic medullary histology" to nonmedullary poorly differentiated histologies and demonstrated significant overlapping between categories. By assessing a selected subset (n=30) that represented the spectrum of histologies, we showed that the interobserver agreement for diagnosing medullary carcinoma by using 2010 World Health Organization criteria was poor; the κ value among 5 gastrointestinal pathologists was only 0.157 (95% confidence interval, 0.127-0.263; P=.001). When we arbitrarily classified the entire cohort into "classic" and "indeterminate" medullary tumors (group 1, n=19; group 2, n=26, respectively) and nonmedullary poorly differentiated tumors (group 3, n=35), groups 1 and 2 were more likely to exhibit mismatch repair protein deficiency than group 3 (P |
| Databáze: | OpenAIRE |
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