Clinical and pathological tools for identifying microsatellite instability in colorectal cancer.
OBJECTIVE
To assess practical accuracy of revised Bethesda criteria (BGrev), pathological predictive model (MsPath), and histopathological parameters for detection of high-frequency of microsatellite instability (MSI-H) phenotype in patients with colorectal carcinoma (CRC).


METHODS
Tumors from 150 patients with CRC were analyzed for MSI using a fluorescence-based pentaplex polymerase chain reaction technique. For all patients, we evaluated age, sex, family history of cancer, localization, tumor differentiation, mucin production, lymphocytic infiltration (TIL), and Union for International Cancer Control stage. Patients were classified according to the BGrev, and the groups were compared. The utility of the BGrev, MsPath, and clinical and histopathological parameters for predicting microsatellite tumor status were assessed by univariate logistic regression analysis and by calculating the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values.


RESULTS
Fifteen out of 45 patients who met and 4 of 105 patients who did not meet the BGrev criteria had MSI-H CRC. Sensitivity, specificity, PPV, and NPV for BGrev were 78.9%, 77%, 30%, and 70%, respectively. MSI histology (the third BGrev criterion without age limit) was as sensitive as BGrev, but more specific. MsPath model was more sensitive than BGrev (86%), with similar specificity. Any BGrev criterion fulfillment, mucinous differentiation, and right-sided CRC were singled out as independent factors to identify MSI-H colorectal cancer.


CONCLUSIONS
The BGrev, MsPath model, and MSI histology are useful tools for selecting patients for MSI testing.
First Surgical Clinic, Koste Todorovica 6, 11000 Belgrade, Serbia. scpy@beotel.net
Zoran
Z
Krivokapić
Srdjan
S
Marković
Jadranka
J
Antić
Ivan
I
Dimitrijević
Daniela
D
Bojić
Petar
P
Svorcan
Njegica
N
Jojić
Svetozar
S
Damjanović
D000368:Aged; D002277:Carcinoma / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D011237:Predictive Value of Tests