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Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles.
Mod Pathol 2016; 29(9):977-84MP

Abstract

Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ=0.41, P<0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ=0.56, P<0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ=0.43, P<0.01; κ=0.38, P<0.01; κ=0.17, P<0.01; κ=0.08, P<0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes.

Authors+Show Affiliations

Department of Pathology, University of Chicago, Chicago, IL, USA.Department of Pathology, University of Florida, Gainesville, FL, USA.Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA.Department of Pathology, Mayo Clinic, Scottsdale, AZ, USA.Department of Pathology, University of Chicago, Chicago, IL, USA.Department of Pathology, University of Chicago, Chicago, IL, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27198568

Citation

Kwak, Heewon A., et al. "Interobserver Variability in Intraductal Papillary Mucinous Neoplasm Subtypes and Application of Their Mucin Immunoprofiles." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 29, no. 9, 2016, pp. 977-84.
Kwak HA, Liu X, Allende DS, et al. Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles. Mod Pathol. 2016;29(9):977-84.
Kwak, H. A., Liu, X., Allende, D. S., Pai, R. K., Hart, J., & Xiao, S. Y. (2016). Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 29(9), pp. 977-84. doi:10.1038/modpathol.2016.93.
Kwak HA, et al. Interobserver Variability in Intraductal Papillary Mucinous Neoplasm Subtypes and Application of Their Mucin Immunoprofiles. Mod Pathol. 2016;29(9):977-84. PubMed PMID: 27198568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interobserver variability in intraductal papillary mucinous neoplasm subtypes and application of their mucin immunoprofiles. AU - Kwak,Heewon A, AU - Liu,Xiuli, AU - Allende,Daniela S, AU - Pai,Rish K, AU - Hart,John, AU - Xiao,Shu-Yuan, Y1 - 2016/05/20/ PY - 2016/02/17/received PY - 2016/04/15/revised PY - 2016/04/16/accepted PY - 2016/5/21/entrez PY - 2016/5/21/pubmed PY - 2018/1/24/medline SP - 977 EP - 84 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod. Pathol. VL - 29 IS - 9 N2 - Intraductal papillary mucinous neoplasm is considered a precursor lesion to pancreatic adenocarcinoma. These are further classified into four histologic subtypes: gastric, intestinal, pancreatobiliary, and oncocytic. The first aim of this study was to assess the interobserver variability among five gastrointestinal pathologists in diagnosing intraductal papillary mucinous neoplasm subtypes by morphology alone. The second aim of the study was to compare intraductal papillary mucinous neoplasm subtypes, which received consensus diagnoses (≥80% agreement) with their respective mucin immunoprofiles (MUC1, MUC2, MUC5AC, MUC6, and CDX2). A consensus histologic subtype was reached in 58% of cases (29/50) among the five gastrointestinal pathologists. Overall there was moderate agreement (κ=0.41, P<0.01) in subtyping intraductal papillary mucinous neoplasms without the use of immunohistochemistry. The histologic subtype with the best interobserver agreement was intestinal type (κ=0.56, P<0.01) followed by pancreatobiliary, gastric, mixed, and oncocytic types (κ=0.43, P<0.01; κ=0.38, P<0.01; κ=0.17, P<0.01; κ=0.08, P<0.04, respectively). Both kappa values for mixed and oncocytic subtypes were likely artificially low due to the underrepresentation of these subtypes in this study and not a true indication of poor interobserver agreement. Following an intradepartmental consensus meeting between two gastrointestinal pathologists, 68% of cases (34/50) received a consensus intraductal papillary mucinous neoplasm subtype. Sixty-nine percent of cases (11/16) that did not receive a consensus intraductal papillary mucinous neoplasm subtype could be classified based on their respective immunoprofiles. Standardizing the use of immunohistochemistry with a mucin immunopanel (MUC1, MUC2, MUC5AC, and MUC6) may improve the agreement of diagnosing intraductal papillary mucinous neoplasm histologic subtypes. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/27198568/Interobserver_variability_in_intraductal_papillary_mucinous_neoplasm_subtypes_and_application_of_their_mucin_immunoprofiles_ L2 - http://dx.doi.org/10.1038/modpathol.2016.93 DB - PRIME DP - Unbound Medicine ER -