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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] [What about the content of this article? (0)] [Affiliation(s)] [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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