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Grading epithelial atypia in endoscopic ultrasound-guided fine-needle aspiration of intraductal papillary mucinous neoplasms: an international interobserver concordance study.
Cancer Cytopathol 2013; 121(12):729-36CC

Abstract

BACKGROUND

Preoperative cytological analysis of cyst fluid from intraductal papillary mucinous neoplasms (IPMN) contributes to risk stratification for malignancy. To the authors' knowledge, agreement among pathologists in grading epithelial atypia in IPMN cyst fluids has not been studied to date.

METHODS

Blinded to the histological grade, 4 observers independently graded 60 cell groups from endoscopic ultrasound-guided fine-needle aspiration samples of 24 IPMNs of various grades as either 0 (nonlesional), 1 (low-grade dysplasia), 2 (intermediate-grade dysplasia [IGD]), 3 (high-grade dysplasia), or 4 (invasive adenocarcinoma). The percentage of agreement and the kappa (k) coefficient were calculated for these 5 tiers and a reduced 2-tier grouping (low-grade [LG] [0-1 and 0-2] vs high-grade [HG] [2-4 and 3-4]). Agreement between the 2 most experienced reviewers established a consensus diagnosis that was compared with the histological grade.

RESULTS

Among the 4 reviewers there was poor agreement using a 5-tiered system and fair agreement with the 2-tiered system. LG and HG grouping of IGD did not appear to greatly affect agreement, with 54% agreement for grouping 0 to 2 and 3 to 4 (k = 0.45) and 52% agreement for grouping 0 to 1 and 2 to 4 (k = 0.44). The 2 most experienced reviewers had 87% agreement for the 0 to 2 and 3 to 4 grouping (k = 0.74) and 88% for the 0 to 1 and 2 to 4 grouping (k = 0.71). HG atypia on cytology with IGD grouped as LG yielded a sensitivity of 82%, with a specificity of 70% for detecting a cyst with HG morphology.

CONCLUSIONS

Grading cellular atypia in cyst fluids requires experience, which results in very good interobserver agreement and good correlation with histology using a 2-tiered LG and HG grading system and IGD classified as LG.

Authors+Show Affiliations

Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23881863

Citation

Pitman, Martha B., et al. "Grading Epithelial Atypia in Endoscopic Ultrasound-guided Fine-needle Aspiration of Intraductal Papillary Mucinous Neoplasms: an International Interobserver Concordance Study." Cancer Cytopathology, vol. 121, no. 12, 2013, pp. 729-36.
Pitman MB, Centeno BA, Genevay M, et al. Grading epithelial atypia in endoscopic ultrasound-guided fine-needle aspiration of intraductal papillary mucinous neoplasms: an international interobserver concordance study. Cancer Cytopathol. 2013;121(12):729-36.
Pitman, M. B., Centeno, B. A., Genevay, M., Fonseca, R., & Mino-Kenudson, M. (2013). Grading epithelial atypia in endoscopic ultrasound-guided fine-needle aspiration of intraductal papillary mucinous neoplasms: an international interobserver concordance study. Cancer Cytopathology, 121(12), pp. 729-36. doi:10.1002/cncy.21334.
Pitman MB, et al. Grading Epithelial Atypia in Endoscopic Ultrasound-guided Fine-needle Aspiration of Intraductal Papillary Mucinous Neoplasms: an International Interobserver Concordance Study. Cancer Cytopathol. 2013;121(12):729-36. PubMed PMID: 23881863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Grading epithelial atypia in endoscopic ultrasound-guided fine-needle aspiration of intraductal papillary mucinous neoplasms: an international interobserver concordance study. AU - Pitman,Martha B, AU - Centeno,Barbara A, AU - Genevay,Muriel, AU - Fonseca,Ricardo, AU - Mino-Kenudson,Mari, Y1 - 2013/07/23/ PY - 2013/05/14/received PY - 2013/06/10/accepted PY - 2013/7/25/entrez PY - 2013/7/25/pubmed PY - 2014/2/11/medline KW - cytology KW - endoscopic ultrasound KW - epithelial atypia KW - fine-needle aspiration KW - interobserver KW - intraductal papillary mucinous neoplasm KW - pancreas KW - variability SP - 729 EP - 36 JF - Cancer cytopathology JO - Cancer Cytopathol VL - 121 IS - 12 N2 - BACKGROUND: Preoperative cytological analysis of cyst fluid from intraductal papillary mucinous neoplasms (IPMN) contributes to risk stratification for malignancy. To the authors' knowledge, agreement among pathologists in grading epithelial atypia in IPMN cyst fluids has not been studied to date. METHODS: Blinded to the histological grade, 4 observers independently graded 60 cell groups from endoscopic ultrasound-guided fine-needle aspiration samples of 24 IPMNs of various grades as either 0 (nonlesional), 1 (low-grade dysplasia), 2 (intermediate-grade dysplasia [IGD]), 3 (high-grade dysplasia), or 4 (invasive adenocarcinoma). The percentage of agreement and the kappa (k) coefficient were calculated for these 5 tiers and a reduced 2-tier grouping (low-grade [LG] [0-1 and 0-2] vs high-grade [HG] [2-4 and 3-4]). Agreement between the 2 most experienced reviewers established a consensus diagnosis that was compared with the histological grade. RESULTS: Among the 4 reviewers there was poor agreement using a 5-tiered system and fair agreement with the 2-tiered system. LG and HG grouping of IGD did not appear to greatly affect agreement, with 54% agreement for grouping 0 to 2 and 3 to 4 (k = 0.45) and 52% agreement for grouping 0 to 1 and 2 to 4 (k = 0.44). The 2 most experienced reviewers had 87% agreement for the 0 to 2 and 3 to 4 grouping (k = 0.74) and 88% for the 0 to 1 and 2 to 4 grouping (k = 0.71). HG atypia on cytology with IGD grouped as LG yielded a sensitivity of 82%, with a specificity of 70% for detecting a cyst with HG morphology. CONCLUSIONS: Grading cellular atypia in cyst fluids requires experience, which results in very good interobserver agreement and good correlation with histology using a 2-tiered LG and HG grading system and IGD classified as LG. SN - 1934-6638 UR - https://www.unboundmedicine.com/medline/citation/23881863/Grading_epithelial_atypia_in_endoscopic_ultrasound_guided_fine_needle_aspiration_of_intraductal_papillary_mucinous_neoplasms:_an_international_interobserver_concordance_study_ L2 - https://doi.org/10.1002/cncy.21334 DB - PRIME DP - Unbound Medicine ER -