Interobserver variability of laryngeal mucosal premalignant lesions: A histopathological evaluation
Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. Modern Pathology
(Impact Factor: 6.19).
04/2011; 24(7):892-8. DOI: 10.1038/modpathol.2011.50
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.
Available from: Jan B Vermorken
- ". Close to 50% of subjects had mild dysplasia however, raising the question as to the effectiveness of this intervention in higher grade dysplasia. Moreover, the considerable intra-and inter-observer variability in the classification of these lesions in combination with the limited number of cases of this study requires confirmation of these results in larger series before any conclusions can be drawn . In another randomized pilot study of celecoxib at 100 or 200 mg versus placebo Table 1 Trials using retinoids in premalignancies and SPT prevention of HNSCC. "
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ABSTRACT: The concept of chemoprevention whereby the use of a systemic agent is intended to halt the carcinogenesis process has been an attractive topic in head and neck squamous cell carcinoma (HNSCC). Yet, despite the significant efforts over the past decades and the substantial gain in knowledge of the biology of pre-malignant lesions of the head and neck, no tangible indications for chemoprevention have emerged for this disease. The negative results observed in the earlier larger studies using retinoids did not encourage further trials with these agents. Attention has been more recently focused on epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) as well as cyclo-oxygenase 2 (COX-2) inhibitors with early studies showing encouraging responses but rather poor tolerance to therapy. Natural compounds have gained more interest recently given preclinical evidence of activity as well as a low side effect profile. We herein offer a comprehensive overview of the field of chemoprevention in HNSCC with an in depth analysis of the challenges we face and discuss a road map for future directions.
Copyright © 2014 Elsevier Ltd. All rights reserved.
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ABSTRACT: Oral leukoplakia is a potentially malignant disorder that will develop into oral cancer at an estimated rate of 1-2% per year. Aim of the present study is to assess the possible predictive value of DNA ploidy for malignant progression of oral leukoplakia. A cohort of 62 leukoplakia patients was studied and their biopsy was examined with standard histopathology and DNA image cytometry. Cox regression analysis was performed to establish the relationship between progression-free survival and the DNA ploidy status. During the follow-up time (median of 69 months) 13 patients developed an oral squamous cell carcinoma (OSCC). DNA aneuploidy was observed in 27 (44%) patients and was significantly associated with a shorter progression-free survival [Hazard ratio of 3.7, 95% confidence intervals (CI) of 1.1 and 13.0 and a p-value of 0.04]. Sensitivity and specificity scores were 54% and 60%, respectively. Aneuploidy was not correlated with dysplasia grading (chi-square analysis). DNA aneuploidy in oral leukoplakia is associated with an increased risk of progression to OSCC. However, for the individual leukoplakia patient, DNA ploidy status as single biomarker has limited value to predict progression to cancer.
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ABSTRACT: It can be confusing for clinicians to work their way through the tangle of pathologic terms used in surgical pathology reports to describe squamous abnormalities in laryngeal biopsies. After a brief review of the normal microscopic anatomy of the larynx and time-honored clinical designations for surface-based abnormalities, this report sorts pathologic changes into 2 groups: those changes that do not carry a premalignant potential (including squamous metaplasia, squamous hyperplasia, pseudoepitheliomatous hyperplasia, keratosis, and parakeratosis) and those that do (including dyskeratosis, laryngeal intraepithelial neoplasia [LIN], atypia, dysplasia, and carcinoma in situ). Generally, lesions in the first group do not require additional therapy or close follow-up; lesions in the second group, however, demand either some form of local therapy or close follow-up to monitor for the development of a more aggressive pathology. © 2011 Wiley Periodicals, Inc. Head Neck, 2011
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