title: Interobserver variability in the application of a proposed histologic subclassification of endocervical adenocarcinoma.
abstract: A histologic pattern-based system of risk stratification for endocervical adenocarcinoma has been recently proposed on the basis of tumor-stroma interface and lymph-vascular invasion. The key utility of the system lies in separating cases with very low risk for nodal metastases (pattern A) from those with higher risk (patterns B and C), which may alter the treatment approach. In this study, we determine the reproducibility of applying this system among gynecologic pathologists from 2 institutions using blinded review of 49 adenocarcinomas from 2003 to 2013. κ values and pairwise differences are calculated for the proposed 3-tier system (patterns A, B, and C) as well as a modified version comparing pattern A versus patterns B and C combined (2-tier system). Consensus diagnosis for the 3-tier system is reached in 50% of cases, with majority of κ values indicating fair to almost perfect agreement (range, 0.24 to 0.84). When condensed to 2 tiers, consensus is reached in 81.3% of cases with κ values showing modest improvement (range, 0.33 to 0.92). Pairwise difference analysis reveals diagnosis trends for specific pathologists on the 3-tier system that decrease with 2 tiers. Interpretive variability may be of practical significance in application of the proposed 3-tier pattern-based approach to endocervical adenocarcinoma. Additional studies with larger patient cohorts are needed to confirm the negligible risk for lymph node involvement seen in pattern A patients and to further evaluate the applicability of this new classification system.
authors.affiliation: *Department of Pathology and Laboratory Medicine, University of Virginia Health System ‡Department of Health Evaluation Sciences, University of Virginia School of Medicine, Charlottesville, VA †Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Cherie
authors.initials: C
authors.lastname: Paquette
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Jeffus
authors.forename: Charles M
authors.initials: CM
authors.lastname: Quick
authors.forename: Mark R
authors.initials: MR
authors.lastname: Conaway
authors.forename: Mark H
authors.initials: MH
authors.lastname: Stoler
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Atkins
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000378:metabolism / Q000473:pathology*; D001706:Biopsy; D032921:Consensus; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000473:pathology*