Impact of standardised reporting in adrenocortical carcinoma: a single centre clinicopathological review.
OBJECTIVE
Structured multicentre efforts are needed if the prognosis of adrenocortical carcinoma (ACC) is to be improved. Data collection may be enhanced through standardised histopathological reporting using criteria such as the recently published Royal College of Pathologists' (UK) minimum dataset (MDS). This study aimed to perform a clinicopathological review of the adult patients treated at the Royal Victoria Infirmary, Newcastle upon Tyne, in the 10 years preceding the MDS.


METHODS
Case records were examined for all patients diagnosed with ACC between 1996 and 2006. Pathology was reviewed and compared with the Royal College of Pathologists' MDS along with the original reports. A systematic evaluation of Ki-67 immunolabelling was also performed.


RESULTS
Eleven patients with ACC were diagnosed and treated. Histopathological reporting according to the MDS identified more features of malignancy than in the original reports (8.5+/-1.2 versus 5.1+/-0.8, p<0.02). The median number of microscopic criteria of malignancy was 7 (range 5-10), with > or =5 features occurring in all cases. The most commonly observed features of malignancy were diffuse architecture, <25% clear cells, confluent necrosis, abnormal mitoses and mitotic count > or =6 per 50 high-power fields. Capsular invasion and > or =8 MDS criteria of malignancy were associated with a worse outcome (each p<0.01). Median Ki-67 index was 19.0% (range 3.7-44.1%) and was not apparently related to survival.


CONCLUSIONS
Standardised criteria for histopathological reporting of ACC will improve the accuracy of data for cancer registration and may also assist in individual patient stratification. An elevated Ki-67 index is a feature of ACC, although it does not appear to predict individual patient survival.
Department of Endocrinology, The Newcastle upon Tyne NHS University Hospital Foundation Trust, Newcastle upon Tyne, UK.
A
A
Advani
S
S
Vaikkakara
M S
MS
Gill
C S
CS
Arun
S H
SH
Pearce
S G
SG
Ball
R A
RA
James
T W J
TW
Lennard
R D
RD
Bliss
R
R
Quinton
S J
SJ
Johnson
D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D018268:Adrenocortical Carcinoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004739:England; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D019394:Ki-67 Antigen; D008939:Mitotane