title: Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma.
abstract: BACKGROUND
  -Low interobserver diagnostic agreement exists among high-grade endometrial carcinomas.
  
  
  OBJECTIVE
  -To evaluate diagnostic variability in International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid adenocarcinoma (G3EC) in 2 different sign-out practices.
  
  
  METHODS
  -Sixty-six G3EC cases were identified from pathology archives of Wayne State University (WSU, Detroit, Michigan) (general surgical pathology sign-out) and 65 from Memorial Sloan Kettering Cancer Center (MSK, New York, New York) (gynecologic pathology focused sign-out). Each case was reviewed together by 2 gynecologic pathologists, one from each institution, and classified into the G3EC group or a reclassified group. Clinicopathologic parameters were compared.
  
  
  RESULTS
  -Twenty-five WSU cases (38%) were reclassified as undifferentiated (n = 2), serous (n = 4), mixed endometrioid and serous carcinomas (n = 12), and FIGO grade 2 endometrioid adenocarcinomas with focal marked nuclear atypia (n = 7). Eleven MSK cases (17%) were reclassified as undifferentiated (n = 5), serous (n = 1), mixed endometrioid and serous carcinomas (n = 4), and mixed endometrioid and clear cell carcinomas (n = 1). Agreement rate between original and review diagnosis was 83% (54 of 65) at MSK and 62% (41 of 66) at WSU (P = .01) with an overall rate of 73% (95 of 131). There were more undifferentiated carcinomas at MSK than there were at WSU (45% [5 of 11] versus 8% [2 of 25]; P = .02). There were more grade 2 endometrioid adenocarcinomas with focal, marked nuclear atypia at WSU (28%; 7 of 25) than there were at MSK (0%) (P = .03). Mixed endometrioid and serous carcinoma was the most common misclassified subtype (44%; 16 of 36).
  
  
  CONCLUSIONS
  -Moderate interobserver variability exists in the diagnosis of G3EC with a significantly greater diagnostic agreement rate in gynecologic pathology-focused sign-out than in general sign-out practice.
authors.forename: Sumi
authors.initials: S
authors.lastname: Thomas
authors.forename: Yaser
authors.initials: Y
authors.lastname: Hussein
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Bandyopadhyay
authors.forename: Michele
authors.initials: M
authors.lastname: Cote
authors.forename: Oudai
authors.initials: O
authors.lastname: Hassan
authors.forename: Eman
authors.initials: E
authors.lastname: Abdulfatah
authors.forename: Baraa
authors.initials: B
authors.lastname: Alosh
authors.forename: Hui
authors.initials: H
authors.lastname: Guan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.affiliation: From the Departments of Pathology (Drs Thomas, Bandyopadhyay, Hassan, Abdulfatah, Alosh, Guan, and Ali-Fehmi), and Oncology (Dr Cote), Wayne State University School of Medicine, Detroit, Michigan; and the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Drs Hussein and Soslow).
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D015588:Observer Variation; D000072142:Pathologists / Q000592:standards; D010338:Pathology, Clinical / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000175:diagnosis*