Interobserver agreement and practice patterns for grading of colorectal carcinoma: World Health Organization (WHO) classification of tumours 5th edition versus American Joint Committee on Cancer (AJCC) 8th edition staging manual

IF 3.9 2区医学 Q2 CELL BIOLOGY

Histopathology Pub Date : 2025-01-28 DOI:10.1111/his.15415

Dipti M Karamchandani, Raul S Gonzalez, Hwajeong Lee, Maria Westerhoff, Brian Cox, Rish K Pai

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引用次数: 0

Abstract

Aims

The current American Joint Committee on Cancer (AJCC) staging manual and the College of American Pathologists (CAP) colorectal carcinoma (CRC) protocol specify use of a four-tiered grading system (i.e. grades 1–4; well-differentiated–undifferentiated) for CRC, based on percentage of gland formation. The World Health Organization (WHO) 5th edition grades CRC into low-grade (well- and moderately differentiated) and high-grade (poorly and undifferentiated), based on the least differentiated component. We studied interobserver agreement and practice patterns among pathologists when grading CRC by these two grading systems.

Methods and results

Five gastrointestinal pathologists reviewed 100 scanned CRC slides and graded the tumour on each slide, per provided criteria in (a) WHO 5th edition book, (b) AJCC manual/CAP CRC protocol and (c) their clinical practice. A questionnaire for grading selected CRC subtypes was also provided. Statistical analysis was performed using Pearson's χ² test and Fleiss multi-rater kappa analyses. Overall, agreement among the five reviewers when grading via WHO and AJCC criteria for low-grade and high-grade CRC was moderate (κ = 0.568, P < 0.001) and good (κ = 0.611, P < 0.001), respectively. All reviewers graded significantly more tumours as high-grade when using WHO (median = 46) versus AJCC/CAP criteria (median = 20).

Conclusions

Interobserver agreement was higher using the AJCC grading criteria as a two-tiered system. Significantly more tumours were called high-grade using the WHO criteria. This raises concerns regarding upgrading tumours, as well as potential differences in grading tumours among pathologists worldwide, based on regional preferred grading systems. Synchronisation of these two grading systems is necessary for uniform grading of CRCs throughout institutions.

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结直肠癌分级的观察者间共识和实践模式：世界卫生组织（WHO）肿瘤分类第5版与美国癌症联合委员会（AJCC）第8版分期手册

目的：目前的美国癌症联合委员会（AJCC）分期手册和美国病理学家学会（CAP）结直肠癌（CRC）协议指定使用四层分级系统(即1-4级；基于腺体形成的百分比，为结直肠癌的良好分化（未分化）。世界卫生组织（WHO）第5版根据分化程度最低的成分，将结直肠癌分为低级别（分化良好和中等）和高级别（分化差和未分化）。我们研究了病理学家在使用这两种分级系统对结直肠癌进行分级时的观察者之间的共识和实践模式。方法和结果：五名胃肠道病理学家审查了100张扫描的CRC切片，并根据(a) WHO第5版书籍，(b) AJCC手册/CAP CRC协议和(c)他们的临床实践提供的标准，在每张切片上对肿瘤进行分级。还提供了一份调查问卷，用于对选定的CRC亚型进行分级。统计学分析采用Pearson’s χ2检验和Fleiss多因子kappa分析。总体而言，五位评论者在使用WHO和AJCC标准对低级别和高级别CRC进行评分时的一致性为中等（κ = 0.568， P）。结论：使用AJCC评分标准作为两级系统时，观察者之间的一致性更高。根据世界卫生组织的标准，更多的肿瘤被称为高级别肿瘤。这引起了对肿瘤升级的关注，以及世界范围内病理学家基于区域首选分级系统对肿瘤分级的潜在差异。这两种评分制度必须同步进行，才能在各院校统一评定中心的评分。

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来源期刊

Histopathology 医学-病理学

CiteScore

10.20

自引率

4.70%

发文量

239

审稿时长

1 months

期刊介绍： Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.