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Debating Deposits, Redux: Substantial Interobserver Agreement Exists in Distinguishing Tumor Deposits From Nodal Metastases in Small Bowel Neuroendocrine Tumors
- Source :
- Archives of Pathology & Laboratory Medicine. May, 2024, Vol. 148 Issue 5, p581, 7 p.
- Publication Year :
- 2024
-
Abstract
- * Context.--Recent data suggest mesenteric tumor deposits (MTDs) indicate poor prognosis in small bowel well-differentiated neuroendocrine tumors (SB-NETs), including compared to positive lymph nodes, making their distinction crucial. Objective.--To study interobserver agreement in distinguishing SB-NET MTDs from positive nodes. Design.--Virtual slides from 36 locally metastatic SBNET foci were shared among 7 gastrointestinal pathologists, who interpreted each as an MTD or a positive node. Observers ranked their 5 preferred choices among a supplied list of potentially useful histologic features, for both options. Diagnostic opinions were compared using Fleiss multirater and Cohen weighted k analyses. Results.--Preferred criteria for MTD included irregular shape (n = 7, top choice for 5), perineural invasion/nerve entrapment (n = 7, top choice for 2), encased thick-walled vessels (n = 7), and prominent fibrosis (n = 6). Preferred criteria for positive nodes included peripheral lymphoid follicles (n = 6, top choice for 4), round shape (n = 7, top choice for 2), peripheral lymphocyte rim (n = 7, top choice for 1), subcapsular sinuses (n = 7), and a capsule (n = 6). Among 36 foci, 10 (28%) each were unanimously diagnosed as MTD or positive node. For 13 foci (36%), there was a diagnosis favored by most observers (5 or 6 of 7): positive node in 8, MTD in 5. Only 3 cases (8%) had a near-even (4:3) split. Overall agreement was substantial ([kappa] = .64, P < .001). Conclusions.--Substantial interobserver agreement exists for distinguishing SB-NET MTDs from lymph node metastases. Favored histologic criteria in making the distinction include irregular shape and nerve/vessel entrapment for MTD, and peripheral lymphocytes/lymphoid follicles and round shape for positive nodes.<br />Well-differentiated neuroendocrine tumors of the small bowel (SB-NETs), in particular of the jejunum and ileum, have a propensity for locoregional as well as distant metastasis. Up to 72% of SB-NETs [...]
- Subjects :
- Metastasis -- Prognosis
Health
Subjects
Details
- Language :
- English
- ISSN :
- 15432165
- Volume :
- 148
- Issue :
- 5
- Database :
- Gale General OneFile
- Journal :
- Archives of Pathology & Laboratory Medicine
- Publication Type :
- Academic Journal
- Accession number :
- edsgcl.794075608
- Full Text :
- https://doi.org/10.5858/arpa.2023-0169-OA