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Birtolo MF, Jouinot A, Vasiljevic A, Boulagnon-Rombi C, Asioli S, Bousdira G, Tetka LMM, Perbet R, Maurage CA, Appay R, Figarella-Branger D, Gauchotte G, Sturm N, Baussart B, Roncaroli F, Bertherat J, Brue T, Villa C. PIT-EASY survey: validation of the European Pituitary Pathology Group proposal for reporting pituitary neuroendocrine tumors. Virchows Arch 2024:10.1007/s00428-024-03849-x. [PMID: 38907774 DOI: 10.1007/s00428-024-03849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024]
Abstract
The aim of this multicenter prospective survey called PIT-EASY was to assess the relevance of the European Pituitary Pathology Group (EPPG) diagnostic tools for pituitary neuroendocrine tumors (PitNETs) to improve the quality of their histological diagnosis. Each center performed at least 30 histological cases of PitNETs using the EPPG tools and assessed their value using a scorecard with 10 questions. For each center, the histological cases were carried out by pathologists with varying levels of expertise in pituitary pathology defined as junior, intermediate, and expert. Two hundred and ninety histological cases were collected from six French and Italian centers. The three EPPG tools were validated and regarded as helpful for a more accurate and time-efficient diagnosis. The usefulness of level 2 and level 3 of the "EPPG's multi-step approach for immunohistochemistry" including pituitary transcription factors (PIT1, TPIT, and SF1) and chromogranin, SSTRs, and P53 respectively was higher in "other non-functioning" (silent plurihormonal PIT1, silent corticotroph, and null cell): 88% vs 32%, p < 10-6 and 42% vs 14%, p = 0.002, respectively. The diagnostic algorithm proved more useful for junior pathologists (p = 0.0001) and those with intermediate experience. PIT-EASY survey confirmed the importance of a standardized approach to PitNETs for an accurate and reproducible diagnosis and served as validation of the EPPG proposal. The tool appeared to be of practical value to junior participants and staff with intermediate experience for safe routine diagnostic reporting.
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Affiliation(s)
- Maria Francesca Birtolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
| | - Anne Jouinot
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
- Service d'Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Alexandre Vasiljevic
- Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, 69373, Lyon, France
- Pathology Department, Center for Rare Pituitary Diseases (CRMR HYPO), "Groupement Hospitalier Est" Hospices Civils de Lyon, 69677, Bron, France
| | - Camille Boulagnon-Rombi
- Service de Pathologie, CHU de Reims, 51092, Reims, France
- CNRS, MEDyC UMR 7369, Université de Reims Champagne Ardenne, 51097, Reims, France
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Pituitary Unit, Referent Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ghizelaine Bousdira
- Service de Pathologie, CHU de Reims, 51092, Reims, France
- CNRS, MEDyC UMR 7369, Université de Reims Champagne Ardenne, 51097, Reims, France
| | - Louise Marie Mboua Tetka
- Service de Pathologie, CHU de Reims, 51092, Reims, France
- CNRS, MEDyC UMR 7369, Université de Reims Champagne Ardenne, 51097, Reims, France
| | - Romain Perbet
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, France
| | - Claude-Alain Maurage
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, France
| | - Romain Appay
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Guillaume Gauchotte
- Department of Biopathology, CHRU-ICL, INSERM U1256 NGERE, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Nathalie Sturm
- Department of Anatomo-Cytopathology, Grenoble University Hospital, 38700, La Tronche, France
| | - Bertrand Baussart
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
- Department of Neurosurgery, Hôpital Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jérôme Bertherat
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
- Service d'Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Thierry Brue
- Aix Marseille Univ, AP-HM, Inserm, MMG, MarMaRa, Marseille, France
- Department of Endocrinology, Reference Center for Rare Pituitary Diseases (CRMR HYPO), La Conception University Hospital, AP-HM, Marseille, France
| | - Chiara Villa
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France.
- Department of Neuropathology, Hôpital Universitaire Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.
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Molina TJ, Roden AC, Szolkowska M, Shimizu S, Moreira AL, Chalabreysse L, Besse B, de Montpréville V, Marom EM, Detterbeck F, Girard N, Nicholson AG, Marx A. International reproducibility study of thymic epithelial tumors staging: pT stage is an issue. proposals for improvement. A RYTHMIC/ITMIG study. Lung Cancer 2024; 189:107479. [PMID: 38306885 DOI: 10.1016/j.lungcan.2024.107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Pathologists are staging thymic epithelial tumors (TET) according to the 8th UICC/AJCC TNM system. Within the French RYTHMIC network, dedicated to TET, agreement on pathologic tumor stage (pT) among the pathology panelists was difficult. The aim of our study was to determine the interobserver reproducibility of pT at an international level, to explore the source of discrepancies and potential interventions to address these. METHODS An international panel of pathologists was recruited through the International Thymic Malignancy Interest Group (ITMIG). The study focused on invasion of mediastinal pleura, pericardium, and lung. From a cohort of cases identified as challenging within the RYTHMIC network, we chose a series of test and validation cases (n = 5 and 10, respectively). RESULTS Reproducibility of the pT stage was also challenging at an international level as none of the 15 cases was classified as the same pT stage by all ITMIG pathologists. The agreement rose from slight (κ = 0.13) to moderate (κ = 0.48) between test and validation series. Discussion among the expert pathologists pinpointed two major reasons underlying discrepancies: 1) Thymomas growing with their "capsule" and adhering to the pleurae, pericardium, or lung were often misinterpreted as invading these structures. 2) Recognition of the mediastinal pleura was identified as challenging. CONCLUSION Our study underlines that the evaluation of the pT stage of TET is problematic and needs to be addressed in more detail in an upcoming TNM classification. The publication of histopathologic images of landmarks, including ancillary tests could improve reproducibility for future TNM classifications.
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Affiliation(s)
- Thierry J Molina
- Department of Pathology, Université Paris Cité, Hôpitaux Necker-Enfants Malades et Robert Debré, APHP, INSERM, U1163, Institut IMAGINE, Paris, France.
| | - Anja C Roden
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Malgorzata Szolkowska
- Department of Pathology, The Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Shigeki Shimizu
- Department of Laboratory Medicine and Pathology, NHO Kinki-chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lara Chalabreysse
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France, Paris-Saclay University, Orsay, France
| | | | - Edith M Marom
- Department of Diagnostic Radiology, Tel Aviv University, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Frank Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Nicolas Girard
- Thorax Institute Curie Montsouris, Paris, France, Universite de Versailles Saint Quentin (UVSQ), Paris Saclay University, Versailles, France
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, England
| | - Alexander Marx
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
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