title: Ovarian carcinoma diagnosis: the clinical impact of 15 years of change.
abstract: Until recently ovarian carcinoma was considered to be a single disease, and treatment decisions were based solely on grade and pre- and postoperative tumour burden. New insights into molecular features, treatment response, and patient demographics led the scientific community to conclude that ovarian carcinoma histotypes are different disease entities.
  
  
  
  In 2002, the pathology specimens from patients in a clinical trial were reviewed by an experienced gynaecopathologist (pathologist A) for translational research purposes. All cases were typed according to what were then current criteria. The identical cohort was now reassessed by the same expert pathologist and independently reviewed by another gynaecopathologist (pathologist B) applying WHO 2014 diagnostic criteria. Survival analyses were done based on the original as well as the new diagnoses, and historical biomarker study results were recalculated.
  
  
  
  Upon re-review, pathologist A rendered the same histotype diagnosis in only 54% of cases. In contrast, pathologists A and B independently rendered the same diagnosis in 98% of cases. Histotype was of prognostic significance when 2014 diagnoses were used, but was not prognostic using the original (2002) histotype diagnoses.
  
  
  
  Our study demonstrates a marked shift in ovarian carcinoma histotype diagnosis over the past 15 years. The new criteria are associated with a very high degree of interobserver reproducibility, allowing for treatment decisions based on histotype. Finally, biomarkers of putative prognostic significance were revealed to be primarily histotype-specific markers, confirming the critical importance of obtaining up-to-date diagnoses rather than accepting archival histotype data in clinical research.
authors.affiliation: Department of Women's Health, Tübingen University Hospital, Calwerstrasse 7, 72076 Tübingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kommoss
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, 910 West 10th Avenue, Vancouver, BC, Canada V5Z 4E3.
authors.forename: C Blake
authors.initials: CB
authors.lastname: Gilks
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte (KEM), Henricistraße 92, 45136 Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, 910 West 10th Avenue, Vancouver, BC, Canada V5Z 4E3.|Institute of Pathology, Referral Centre for Gynecopathology, A2/2, 68159 Mannheim, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Kommoss
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology; D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology; D014408:Biomarkers, Tumor; D002277:Carcinoma / Q000145:classification* / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology; D018269:Carcinoma, Endometrioid / Q000175:diagnosis / Q000235:genetics / Q000401:mortality / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D005260:Female; D016161:Genes, Retinoblastoma; D019942:Genes, p16; D006801:Humans; D053208:Kaplan-Meier Estimate; D015337:Multicenter Studies as Topic; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D057170:Translational Research, Biomedical; D014944:World Health Organization
chemical_list: D014408:Biomarkers, Tumor