International study group on rectal cancer regression grading: interobserver variability with commonly used regression grading systems

Chetty, Runjan; Gill, Paul; Govender, Dhirendra; Bateman, Adrian C.; Chang, Hee Jin; Deshpande, Vikram; Driman, David K.; Gómez, Marisa; Greywoode, Godman; Jaynes, Eleanor; Lee, C. Soon; Locketz, Michael; Rowsell, Corwyn; Rullier, Anne; Serra, Stefano; Shepherd, Neil A.; Szentgyörgyi, Eva; Vajpeyi, Rajkumar; Wang, Lai Mun; Bateman, Andrew

doi:10.1016/j.humpath.2012.01.020

Cited by 90 publications

(81 citation statements)

References 16 publications

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“…However, unfortunately, the fundamental tenet of regression grading in the CAP system41 is ‘fibrosis’. Although, the presence of the other well documented hallmarks of regression (mucin pools, necrosis, foamy macrophages, haemosiderin deposition, foreign body giant cell reaction)29 44 45 (figure 2A, B) may aid in distinguishing fibrosis associated with regression from tumour-induced fibrosis. It is important to be aware that these features are not present in all cases and can also occur in the absence of regression.…”

Section: Discussionmentioning

confidence: 99%

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

et al. 2016

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“…A reason for the higher rate of disagreement for the Mandard score may be the existence of difficulties in the assessment of the relative amount of fibrosis. This has been debated to show lack of reproducibility in a recent work by Chetty et al, 25 who investigated the level of interobserver agreement among expert gastrointestinal pathologists for TRG in rectal cancer following neoadjuvant radiochemotherapy. In this study, 17 pathologists applied various regression grading systems for gastrointestinal cancers (eg, the Mandard 7 or the TRG according to the Royal College of Pathologists 26 ) on selected slides of tumors, which resulted in unsatisfactory interobserver agreement for all TRG systems.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Tumor Regression of Esophageal Adenocarcinomas After Neoadjuvant Chemotherapy

Karamitopoulou

Thies

Zlobec

et al. 2014

American Journal of Surgical Pathology

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Histopathologic determination of tumor regression provides important prognostic information for locally advanced gastroesophageal carcinomas after neoadjuvant treatment. Regression grading systems mostly refer to the amount of therapy-induced fibrosis in relation to residual tumor or the estimated percentage of residual tumor in relation to the former tumor site. Although these methods are generally accepted, currently there is no common standard for reporting tumor regression in gastroesophageal cancers. We compared the application of these 2 major principles for assessment of tumor regression: hematoxylin and eosin-stained slides from 89 resection specimens of esophageal adenocarcinomas following neoadjuvant chemotherapy were independently reviewed by 3 pathologists from different institutions. Tumor regression was determined by the 5-tiered Mandard system (fibrosis/tumor relation) and the 4-tiered Becker system (residual tumor in %). Interobserver agreement for the Becker system showed better weighted κ values compared with the Mandard system (0.78 vs. 0.62). Evaluation of the whole embedded tumor site showed improved results (Becker: 0.83; Mandard: 0.73) as compared with only 1 representative slide (Becker: 0.68; Mandard: 0.71). Modification into simplified 3-tiered systems showed comparable interobserver agreement but better prognostic stratification for both systems (log rank Becker: P=0.015; Mandard P=0.03), with independent prognostic impact for overall survival (modified Becker: P=0.011, hazard ratio=3.07; modified Mandard: P=0.023, hazard ratio=2.72). In conclusion, both systems provide substantial to excellent interobserver agreement for estimation of tumor regression after neoadjuvant chemotherapy in esophageal adenocarcinomas. A simple 3-tiered system with the estimation of residual tumor in % (complete regression/1% to 50% residual tumor/>50% residual tumor) maintains the highest reproducibility and prognostic value.

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“…[106][107][108] Most of the different TRG systems for gastrointestinal tumours are relatively simple to use, 102,109,110 although the reported reproducibility of these systems is variable. [111][112][113][114] TRG is usually applied to the primary site of unifocal tumours in the breast and gastrointestinal tract. In contrast, pelvic HGSCs tend to affect multiple intra-abdominal sites in addition to the primary site of origin.…”

Section: Carcinosarcoma Subtypesmentioning

confidence: 99%

Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR)

et al. 2015

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International study group on rectal cancer regression grading: interobserver variability with commonly used regression grading systems

Cited by 90 publications

References 16 publications

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

Assessment of Tumor Regression of Esophageal Adenocarcinomas After Neoadjuvant Chemotherapy

Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR)

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