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A Selective Biomarker Panel Increases the Reproducibility and the Accuracy in Endometrial Biopsy Diagnosis

Nastic, Denis; Shanwell, Emma; Wallin, Keng-Ling; Valla, Marit; Måsbäck, Anna LU ; Mateoiu, Claudia; Lidang, Marianne; Liakka, Annikki; Lappi-Blanco, Elisa and Grove, Anni, et al. (2017) In International Journal of Gynecological Pathology 36(4). p.339-347
Abstract

Grading and histologic typing of endometrial cancer in biopsy material has a direct impact on the decision to perform lymphadenectomy and/or omentectomy in many cancer centers. Endometrial biopsies are among the most common general surgical pathology specimens. Multiple studies have shown that biopsy diagnosis suffers from a lack of reproducibility. Although many biomarkers have been proposed, none have been demonstrated to improve the diagnosis in the biopsy setting. In this study, 70 biopsies with endometrial carcinoma were supplemented with a biomarker panel consisting of ER, PR, P53, and DNA ploidy. A representative H&E slide was scanned digitally and made available to 12 gynecologic pathologists in 4 Nordic countries: Finland,... (More)

Grading and histologic typing of endometrial cancer in biopsy material has a direct impact on the decision to perform lymphadenectomy and/or omentectomy in many cancer centers. Endometrial biopsies are among the most common general surgical pathology specimens. Multiple studies have shown that biopsy diagnosis suffers from a lack of reproducibility. Although many biomarkers have been proposed, none have been demonstrated to improve the diagnosis in the biopsy setting. In this study, 70 biopsies with endometrial carcinoma were supplemented with a biomarker panel consisting of ER, PR, P53, and DNA ploidy. A representative H&E slide was scanned digitally and made available to 12 gynecologic pathologists in 4 Nordic countries: Finland, Denmark, Sweden, and Norway. Reviewers diagnosed the cases both before and after being provided with the biomarker results. The interobserver percent agreement and Cohen κ improved from 75.8% (κ=0.52, moderate) to 84% (κ=0.68, substantial) with inclusion of the biomarker panel. Agreement with the subsequent hysterectomy diagnosis also improved from 83.6% (κ=0.67) to 88.7% (κ=0.77). There was no statistical improvement between a reflex (84% agreement) and a reflective testing algorithm (82.9% agreement), suggesting that the selective use of biomarkers is appropriate. Difficult cases were almost exclusively high-grade tumors. Finally, a statistical model indicated that only P53 and DNA ploidy, in conjunction with an H&E review, had an impact on the decision to upgrade or downgrade cases.

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publication status
published
subject
keywords
biopsies, biomarker, endometri
in
International Journal of Gynecological Pathology
volume
36
issue
4
pages
339 - 347
publisher
Lippincott Williams and Wilkins
external identifiers
  • scopus:85014056286
  • pmid:28244894
  • wos:000403231200006
ISSN
0277-1691
DOI
10.1097/PGP.0000000000000334
language
English
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yes
id
81e40cf8-382c-491c-bca8-ebb43e516c44
date added to LUP
2017-03-17 16:58:10
date last changed
2018-01-07 11:56:18
@article{81e40cf8-382c-491c-bca8-ebb43e516c44,
  abstract     = {<p>Grading and histologic typing of endometrial cancer in biopsy material has a direct impact on the decision to perform lymphadenectomy and/or omentectomy in many cancer centers. Endometrial biopsies are among the most common general surgical pathology specimens. Multiple studies have shown that biopsy diagnosis suffers from a lack of reproducibility. Although many biomarkers have been proposed, none have been demonstrated to improve the diagnosis in the biopsy setting. In this study, 70 biopsies with endometrial carcinoma were supplemented with a biomarker panel consisting of ER, PR, P53, and DNA ploidy. A representative H&amp;E slide was scanned digitally and made available to 12 gynecologic pathologists in 4 Nordic countries: Finland, Denmark, Sweden, and Norway. Reviewers diagnosed the cases both before and after being provided with the biomarker results. The interobserver percent agreement and Cohen κ improved from 75.8% (κ=0.52, moderate) to 84% (κ=0.68, substantial) with inclusion of the biomarker panel. Agreement with the subsequent hysterectomy diagnosis also improved from 83.6% (κ=0.67) to 88.7% (κ=0.77). There was no statistical improvement between a reflex (84% agreement) and a reflective testing algorithm (82.9% agreement), suggesting that the selective use of biomarkers is appropriate. Difficult cases were almost exclusively high-grade tumors. Finally, a statistical model indicated that only P53 and DNA ploidy, in conjunction with an H&amp;E review, had an impact on the decision to upgrade or downgrade cases.</p>},
  author       = {Nastic, Denis and Shanwell, Emma and Wallin, Keng-Ling and Valla, Marit and Måsbäck, Anna and Mateoiu, Claudia and Lidang, Marianne and Liakka, Annikki and Lappi-Blanco, Elisa and Grove, Anni and Davidson, Ben and Carpen, Olli and Bertelsen, Bjørn I. and Bak, Julia and Abusland, Anne B. and Selling, Jonas and Carlson, Joseph W.},
  issn         = {0277-1691},
  keyword      = {biopsies,biomarker,endometri},
  language     = {eng},
  month        = {02},
  number       = {4},
  pages        = {339--347},
  publisher    = {Lippincott Williams and Wilkins},
  series       = {International Journal of Gynecological Pathology},
  title        = {A Selective Biomarker Panel Increases the Reproducibility and the Accuracy in Endometrial Biopsy Diagnosis},
  url          = {http://dx.doi.org/10.1097/PGP.0000000000000334},
  volume       = {36},
  year         = {2017},
}