Histopathological tumour response scoring in resected pancreatic cancer following neoadjuvant therapy: international interobserver study (ISGPP-1)

Author:

Janssen Boris V123,van Roessel Stijn13ORCID,van Dieren Susan13,de Boer Onno23,Adsay Volkan4,Basturk Olca5ORCID,Brosens Lodewijk6,Campbell Fiona7,Chatterjee Deyali8,Chou Angela9,Doglioni Claudio10,Esposito Irene11,Feakins Roger12,Fuchs Talia L9,Fukushima Noriyoshi13,Gill Anthony J9,Hong Seung-Mo14ORCID,Hruban Ralph H15,Kaplan Jeffrey16,Krasinkas Alyssa17,Luchini Claudio18ORCID,Shi Chanjuan19,Singhi Aatur20,Thompson Elizabeth15,Velthuysen Marie-Louise F21ORCID,Besselink Marc G13ORCID,Verheij Joanne23,Wang Huamin8,Verbeke Caroline2223,Fariña Arantza23,

Affiliation:

1. Department of Surgery, Amsterdam UMC, location University of Amsterdam , Amsterdam , the Netherlands

2. Department of Pathology, Amsterdam UMC, location University of Amsterdam , Amsterdam , the Netherlands

3. Cancer Centre Amsterdam , Amsterdam , the Netherlands

4. Department of Pathology, Koc University and KUTTAM Research Centre , Istanbul , Turkey

5. Department of Pathology, Memorial Sloan Kettering Cancer Center , New York, New York , USA

6. Department of Pathology, University Medical Centre Utrecht , Utrecht , the Netherlands

7. Department of Pathology, Royal Liverpool University Hospital , Liverpool , UK

8. Department of Anatomical Pathology, University of Texas MD Anderson Cancer Center , Houston, Texas , USA

9. Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, and University of Sydney , Sydney, New South Wales Australia

10. Department of Pathology, IRCCS San Raffaele Scientific Institute , Milan , Italy

11. Institute of Pathology, Heinrich-Heine-University and University Hospital of Duesseldorf , Duesseldorf , Germany

12. Department of Pathology, Royal Free London NHS Trust , London , UK

13. Department of Pathology, Jichi Medical University Hospital , Tochigi , Japan

14. Department of Pathology, Asan Medical Centre , Seoul, Korea

15. Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

16. Department of Pathology, University of Colorado Hospital , Denver, Colorado , USA

17. Department of Pathology, Emory University , Atlanta, Georgia , USA

18. Department of Diagnostics and Public Health, University and Hospital Trust of Verona , Verona , Italy

19. Department of Pathology, Duke University Medical Center , Durham, North Carolina , USA

20. Department of Pathology, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA

21. Department of Pathology, Erasmus Medical Centre , Rotterdam , the Netherlands

22. Department of Pathology, Institute of Clinical Medicine, University of Oslo , Oslo , Norway

23. Department of Pathology, Oslo University Hospital , Oslo , Norway

Abstract

Abstract Background Most tumour response scoring systems for resected pancreatic cancer after neoadjuvant therapy score tumour regression. However, whether treatment-induced changes, including tumour regression, can be identified reliably on haematoxylin and eosin-stained slides remains unclear. Moreover, no large study of the interobserver agreement of current tumour response scoring systems for pancreatic cancer exists. This study aimed to investigate whether gastrointestinal/pancreatic pathologists can reliably identify treatment effect on tumour by histology, and to determine the interobserver agreement for current tumour response scoring systems. Methods Overall, 23 gastrointestinal/pancreatic pathologists reviewed digital haematoxylin and eosin-stained slides of pancreatic cancer or treated tumour bed. The accuracy in identifying the treatment effect was investigated in 60 patients (30 treatment-naive, 30 after neoadjuvant therapy (NAT)). The interobserver agreement for the College of American Pathologists (CAP) and MD Anderson Cancer Center (MDACC) tumour response scoring systems was assessed in 50 patients using intraclass correlation coefficients (ICCs). An ICC value below 0.50 indicated poor reliability, 0.50 or more and less than 0.75 indicated moderate reliability, 0.75 or more and below 0.90 indicated good reliability, and above 0.90 indicated excellent reliability. Results The sensitivity and specificity for identifying NAT effect were 76.2 and 49.0 per cent respectively. After NAT in 50 patients, ICC values for both tumour response scoring systems were moderate: 0.66 for CAP and 0.71 for MDACC. Conclusion Identification of the effect of NAT in resected pancreatic cancer proved unreliable, and interobserver agreement for the current tumour response scoring systems was suboptimal. These findings support the recently published International Study Group of Pancreatic Pathologists recommendations to score residual tumour burden rather than tumour regression after NAT.

Publisher

Oxford University Press (OUP)

Subject

Surgery

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