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Related Experiment Videos

Anal cancer subtype reproducibility study.

C Fenger1, M Frisch, J J Jass

  • 1Department of Pathology, Odense University Hospital, Denmark. claus.fenger@ouh.dk

Virchows Archiv : an International Journal of Pathology
|April 27, 2000
PubMed
Summary
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Histological subtyping of anal squamous carcinomas by WHO guidelines shows low reliability. Experts demonstrated poor agreement, suggesting the current classification system needs revision for accurate cancer diagnosis.

Area of Science:

  • Oncology
  • Pathology
  • Cancer Research

Background:

  • The World Health Organization (WHO) recommends a six-way histological subtyping system for anal squamous carcinomas.
  • Concerns exist regarding the practical reliability and consistent discrimination of these subtypes among pathologists.

Purpose of the Study:

  • To assess the inter- and intra-pathologist reliability of the WHO histological subtyping of anal squamous carcinomas.
  • To quantify the level of agreement and identify sources of variation in subtype classification.

Main Methods:

  • A blinded study was conducted with 103 anal squamous carcinoma cases.
  • Three expert pathologists from different countries evaluated slides twice, at least 8 months apart.
  • Agreement rates and kappa analyses were used to measure reliability.

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Main Results:

  • Overall inter-pathologist agreement was 61%, and intra-pathologist agreement was 72%.
  • Even for the most common subtype, large-cell keratinising squamous carcinoma, confirmation rates were suboptimal (81% intra-, 71% inter-pathologist).
  • Pathologist certainty did not significantly improve agreement, and 26% of typing variation was attributed to random error.

Conclusions:

  • The current WHO histological subtyping scheme for anal squamous carcinomas demonstrates low reliability in practice.
  • The findings suggest a need for revision of the existing subtyping system to improve diagnostic consistency.
  • The potential role of human papilloma virus (HPV) in anal cancer may warrant further investigation in relation to subtyping schemes.