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.
SourceAvailable from: Panagiota Ravazoula[Show abstract] [Hide abstract]
ABSTRACT: Background. P63 immunostaining has been considered as potential prognostic factor in laryngeal cancer. Considering that P63 is mainly nuclear stain, a possible correlation between the texture of P63-stained nuclei and the tumor's grade could be of value to diagnosis, since this may be related to biologic information imprinted as texture on P63 expressed nuclei. Objective. To investigate the association between P63 stained nuclei and histologic grade in laryngeal tumor lesions. Methods. Biopsy specimens from laryngeal tumour lesions of 55 patients diagnosed with laryngeal squamous cell carcinomas were immunohistochemically (IHC) stained for P63 expression. Four images were digitized from each patient's IHC specimens. P63 positively expressed nuclei were identified, the percentage of P63 expressed nuclei was computed, and 118 textural, morphological, shape, and architectural features were calculated from each one of the 55 laryngeal lesions. Data were split into the low grade (21 grade I lesions) and high grade (34 grade II and grade III lesions) classes for statistical analysis. Results. With advancing grade, P63 expression decreased, P63 stained nuclei appeared of lower image intensity, more inhomogeneous, of higher local contrast, contained smaller randomly distributed dissimilar structures and had irregular shape. Conclusion. P63 expressed nuclei contain important information related to histologic grade.Analytical cellular pathology (Amsterdam) 01/2014; 2014:1-13. DOI:10.1155/2014/963076 · 1.76 Impact Factor
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ABSTRACT: To verify the applicability, reproducibility and predictive value of a proposed unified classification (amended Ljubljana classification) of laryngeal squamous intraepithelial lesions (SILs). Six internationally recognised experts and three pathologists from Ljubljana contributed to this study by evaluating a set of laryngeal SILs using the new system: low-gradeSIL, high-grade SIL and carcinoma in situ (CIS). The overall agreement among reviewers was good. Overall unweighted and weighted κ-statistics and 95% confidence intervals were 0.75 (0.65 - 0.84) and 0.80 (0.71 - 0.87), respectively. The results were stratified between the international reviewers and the Ljubljana pathologists. The former had a good overall agreement, while the latter had very good agreement. Kaplan-Meier survival curves showed a significant difference (p<0.0001) between patients with low- and high-grade SILs; 19/1204 patients with low-grade SILs and 30/240 patients with high-grade SILs progressed to malignancy in 2 to 15 years and in 2 to 26 years, respectively. The proposed modification to the LC classification provides clear morphological criteria to define the prognostic groups. The criteria facilitate better inter-observer agreement than previous systems and the retrospective follow-up study demonstrates a highly significant difference in the risk of malignant progression between low and high grade SILs. This article is protected by copyright. All rights reserved.Histopathology 04/2014; 65(4). DOI:10.1111/his.12427 · 3.30 Impact Factor
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ABSTRACT: The objectives were to determine the prevalence of laryngeal dysplasia and associated human papilloma virus (HPV) subtypes in adult patients, 18 years or older, suffering from laryngeal papillomatosis at a tertiary care institution. Retrospective cohort study. Patients with biopsy proven laryngeal papillomatosis were identified via chart review. All available pathology specimens were reviewed by a dedicated head and neck pathologist to confirm/refute the diagnosis of laryngeal dysplasia, and grade the level of dysplasia. Interrater agreement was compared using cross-tabulation methods. Specimens identified to be positive for dysplasia underwent further testing via in situ hybridization for low-risk (6/11) or high-risk (16/18) HPV subtypes. Of the 85 subjects identified to have laryngeal papillomatosis, 24(28%) demonstrated laryngeal dysplasia. There was good interrater agreement on the presence of dysplasia; however, there was only fair agreement on the grade of dysplasia. Of the pathology specimens tested for HPV subtype, the majority of patients (62%) were positive for HPV 6/11, including all high-grade dysplasia patients. Three (12%) dysplasia specimens were negative for both high- and low-risk HPV subtypes. We found a 28% prevalence of dysplasia in our patient population with the majority of patients positive for low-risk HPV subtypes indicating that high-risk HPV subtypes do not predispose laryngeal papilloma patients to dysplasia.The Annals of otology, rhinology, and laryngology 04/2014; 123(6). DOI:10.1177/0003489414526848 · 1.05 Impact Factor