Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation.
ABSTRACT The objective of this study is to measure interobserver variability in the classification of laryngeal mucosal premalignant lesions by reassessing the histopathology of previously diagnosed cases and to determine the possible therapeutic consequences of disagreement among observers. Histopathological assessment of 110 laryngeal mucosal premalignant lesions was done by three pathologists. Each slide had to be classified according to the World Health Organization, Squamous Intraepithelial Neoplasia, and the Ljubljana Squamous Intraepithelial Lesions systems. After the independent assessment, a joint meeting took place. To assess the relation between histopathological grading and subsequent clinical management, we created a two- and a three-grade system besides one comprising all options. For all analyses, the SAS/STAT statistical software was used. The highest unweighted κ-values concerning the all-options system are observed for the Squamous Intraepithelial Neoplasia classification (0.28, 95% confidence interval 0.23-0.33), followed by the World Health Organization and Ljubljana classifications. For the two-grade system the Ljubljana classification shows the highest unweighted κ-values (0.50, 95%, 0.39-0.61), followed by the World Health Organization and Squamous Intraepithelial Neoplasia classifications. For the three-grade system, the unweighted κ-values are similar. The implementation of weighted κ-values led to higher scores within all three classification systems, although these did not exceed 0.55 (moderate agreement). Given the high level of consensus, simultaneous pathological assessment may be said to provide added value in comparison with independent assessment. In the current study, no clear tendency is observed in favor of any one classification system. The proposed three-grade system could be an improved histopathological tool because it is easier to correlate with clinical decision making and because it yields better unweighted κ-values and proportions of concordance than the all-options system. Furthermore, clinical management could benefit from assessment by more than one pathologist in suspected cases of dysplasia or carcinoma.
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ABSTRACT: Adequate diagnosis, treatment and prognosis of particular pathologic entities of the laryngeal mucosa depend entirely on the histological changes of the epithelium. The basis for the classification of epithelial hyperplastic lesions of the larynx (EHLL) is the progression of the histologic features of these lesions to cancer. Considering various criteria thought to be typical for the transformation of benign EHLL to carcinoma, they are most frequently classified into three different groups. However, difficulties begin with the lack of uniformity and inconsistency of terminology, and the fact that the histomorphological features and biological behavior are not always in accordance. It is emphasized that the surface keratosis in laryngeal pathology has no prognostic significance per se and that the term risky epithelium should replace the expression precancerosis. This term does not predict the evolution of the lesion in any way, and it does not exclude any possible future development; but it warns the laryngologist to exercise extreme caution and to follow the patient closely. Present knowledge of laryngeal cancer, its therapeutic options and consequences, force us to pay increasing attention to early detection and adequate treatment of EHLL.Acta oto-laryngologica. Supplementum 02/1997; 527:7-11.
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ABSTRACT: Different classifications of epithelial hyperplastic lesions of the larynx were proposed, but none of them has been generally accepted. The basic distinction among these gradings is evaluation of carcinoma in situ as a precancerosis or a distinct and separate entity. In the present study, atypical hyperplasia and carcinoma in situ are evaluated according to the proposed histomorphological criteria of the Kambic-Lenart classification. In an attempt to separate more objectively the histomorphological differences between these 2 lesions, in addition to traditional light microscopical examination, we also performed semiquantitative analysis with statistical evaluation using the Wilcoxon signed rank test. These results revealed a significant morphological and statistical difference comparing atypical hyperplasia and carcinoma in situ on the basis of the following criteria: abnormal mitotic figures (p = 0.005), mitotic activity (p = 0.014), nuclear pleomorphism (p = 0.006), cellular atypia (p = 0.005), dyskeratosis (p = 0.008), and stromal infiltration (p = 0.015). These results confirm our view that atypical hyperplasia and carcinoma in situ are 2 consecutive but different entities in the process of carcinonogenesis.Acta oto-laryngologica. Supplementum 02/1997; 527:116-9.
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ABSTRACT: There is no internationally accepted classification of epithelial hyperplastic laryngeal lesions (EHLL). The majority of current classifications follow criteria similar to those commonly used for cervical epithelial lesions. However, the different etiology of laryngeal cancer and its particular clinical and histologic features necessitate a grading system more appropriate to this region. The Ljubljana classification of EHLL was devised in 1971 to cater to this requirement. Detailed criteria for histologic grading in this classification were formulated by a working group on EHLL of the European Society of Pathology in 1999. The system recognizes four grades: simple and abnormal hyperplasia are benign categories; atypical hyperplasia ("risky" epithelium) is potentially malignant, and carcinoma in situ actually malignant. The main features by which the proposed grading system differs from other classifications are: 1. the distinction between benign and potentially malignant lesions; 2. the positive separation of carcinoma in situ from atypical hyperplasia; 3. the lack of prognostic significance for any surface keratin layer. The eventual outcome of EHLL patients so graded justifies the proposal for separating the lesions into a benign group, showing malignant transformation in only 0.9% of cases, from a potentially malignant group showing malignant transformation in 11% of cases. For diagnostically difficult cases, supplementary techniques such as those using morphometry, immunohistochemical and molecular biology are advised to improve the accuracy of diagnosis and predictions of their biological behavior.Advances in Anatomic Pathology 08/2000; 7(4):240-51. · 3.41 Impact Factor