Low interobserver agreement in cytology grading of mucinous pancreatic neoplasms Journal Article
| Authors: | Sigel, C. S.; Edelweiss, M.; Tong, L. C.; Magda, J.; Oen, H.; Sigel, K. M.; Zakowski, M. F. |
| Article Title: | Low interobserver agreement in cytology grading of mucinous pancreatic neoplasms |
| Abstract: | BACKGROUND Identifying high-grade features in patients with pancreatic mucinous neoplasms (MNs) is important for patient management. The reproducibility of MN cytology grading has been evaluated to a limited extent. In the current study, the authors evaluated interobserver variability in grading MNs and the identification of neoplastic mucin in endoscopic ultrasound-guided fine-needle aspiration specimens. METHODS A 54-case grading set was created from histologically confirmed MNs (44 MNs) and nonmucinous lesions with abundant gastrointestinal contamination (10 nonmucinous lesions). Six observers received a tutorial, reviewed prescreened slides, and recorded: 1) a diagnosis according to a 6-tiered system (TS) (nondiagnostic, atypical [ATP], mucinous cyst low grade [MCLG], mucinous cyst high grade, suspicious for adenocarcinoma, and positive for adenocarcinoma); 2) the cyst fluid carcinoembryonic antigen diagnosis (CEADX); and 3) the presence of neoplastic musin. Interobserver agreement (IOA) was evaluated by calculation of kappa coefficients (Kappa). Diagnostic accuracy was not evaluated. RESULTS The IOA was lowest for the 6-TS (Kappa, 0.13; P<.001). The CEADX was available for 18 cases (33%), including 6 of 24 MCLG cases (25%). CEADX modestly improved IOA for combined tiers of the 6-TS with ATP and MCLG as separate categories. The highest IOA was noted with a 3-TS (nondiagnostic, ATP/MCLG, and mucinous cyst high grade/suspicious for adenocarcinoma/positive for adenocarcinoma [Kappa, 0.28; P<.001]) and various 4-TS (Kappa, 0.22-0.23). IOA was found to be low for neoplastic mucin (Kappa = 0.15; P<.001). CONCLUSIONS In a study using simulated cytology practice, observers demonstrated fair IOA for grading MNs and low IOA for identifying neoplastic mucin. Knowledge of the cyst fluid CEA level was found to modestly improve the IOA for low-grade lesions. © 2015 American Cancer Society. |
| Keywords: | major clinical study; cancer diagnosis; cancer grading; pancreas; protein blood level; cytology; carcinoembryonic antigen; cystadenoma; intraductal papillary mucinous tumor; cyst fluid; histology; chronic pancreatitis; pancreas tumor; reliability; grade; mucin; intraductal papillary mucinous neoplasm; mucinous cystic neoplasm; autoimmune pancreatitis; kappa statistics; oncological parameters; interobserver agreement; endoscopic ultrasound guided fine needle biopsy; human; priority journal; article; endoscopic ultrasound-guided fine-needle aspiration (eus-fna); mucinous pancreatic neoplasm; tiered system |
| Journal Title: | Cancer Cytopathology |
| Volume: | 123 |
| Issue: | 1 |
| ISSN: | 1934-662X |
| Publisher: | John Wiley & Sons |
| Date Published: | 2015-01-01 |
| Start Page: | 40 |
| End Page: | 50 |
| Language: | English |
| DOI: | 10.1002/cncy.21492 |
| PROVIDER: | scopus |
| PMCID: | PMC4314357 |
| PUBMED: | 25355052 |
| DOI/URL: | |
| Notes: | Export Date: 2 July 2015 -- Source: Scopus |
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