title: Pattern classification of endocervical adenocarcinoma: reproducibility and review of criteria.
abstract: Previously, our international team proposed a three-tiered pattern classification (Pattern Classification) system for endocervical adenocarcinoma of the usual type that correlates with nodal disease and recurrence. Pattern Classification-A tumors have well-demarcated glands lacking destructive stromal invasion or lymphovascular invasion, Pattern Classification-B tumors show localized, limited destructive invasion arising from A-type glands, and Pattern Classification-C tumors have diffuse destructive stromal invasion, significant (filling a 4 × field) confluence, or solid architecture. Twenty-four cases of Pattern Classification-A, 22 Pattern Classification-B, and 38 Pattern Classification-C from the tumor set used in the original description were chosen using the reference diagnosis originally established. One H&E slide per case was reviewed by seven gynecologic pathologists, four from the original study. Kappa statistics were prepared, and cases with discrepancies reviewed. We found a majority agreement with reference diagnosis in 81% of cases, with complete or near-complete (six of seven) agreement in 50%. Overall concordance was 74%. Overall kappa (agreement among pathologists) was 0.488 (moderate agreement). Pattern Classification-B has lowest kappa, and agreement was not improved by combining B+C. Six of seven reviewers had substantial agreement by weighted kappas (>0.6), with one reviewer accounting for the majority of cases under or overcalled by two tiers. Confluence filling a 4 × field, labyrinthine glands, or solid architecture accounted for undercalling other reference diagnosis-C cases. Missing a few individually infiltrative cells was the most common cause of undercalling reference diagnosis-B. Small foci of inflamed, loose or desmoplastic stroma lacking infiltrative tumor cells in reference diagnosis-A appeared to account for those cases up-graded to Pattern Classification-B. In summary, an overall concordance of 74% indicates that the criteria can be reproducibly applied by gynecologic pathologists. Further refinement of criteria should allow use of this powerful classification system to delineate which cervical adenocarcinomas can be safely treated conservatively.
authors.affiliation: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Joanne K L
authors.initials: JK
authors.lastname: Rutgers
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Andres A
authors.initials: AA
authors.lastname: Roma
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kay J
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Pathology, Pennsylvania State University, State College, PA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Zaino
authors.affiliation: Department of Pathology, Corpath, Columbus, OH, USA.
authors.forename: Abbey
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Hospital de Oncología Centro Médico Nacional Siglo XXI, Ciudad de México, D.F., Mexico.
authors.forename: Isabel
authors.initials: I
authors.lastname: Alvarado
authors.affiliation: Department of Pathology, Juravinski Hospital, Hamilton, ONT, Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Daya
authors.affiliation: Department of Pathology, Toronto East General Hospital, Toronto, ONT, Canada.
authors.forename: Golnar
authors.initials: G
authors.lastname: Rasty
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Teri A
authors.initials: TA
authors.lastname: Longacre
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Ronnett
authors.affiliation: Department of Pathology, MD Anderson Center, Houston, Texas, and Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Elvio G
authors.initials: EG
authors.lastname: Silva
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000556:secondary* / Q000628:therapy; D032921:Consensus; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D015588:Observer Variation; D000072142:Pathologists; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D009626:Terminology as Topic; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000473:pathology* / Q000628:therapy