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Published on: September 15, 2017
The reticulin algorithm for adrenocortical tumor diagnosis: a multicentric validation study on 245 unpublished cases
Eleonora Duregon1, Ambrogio Fassina, Marco Volante
1Departments of *Oncology §§Clinical and Biological Sciences, University of Turin at San Luigi Hospital, Orbassano, Torino †Department of Medicine (DIMED), Pathology and Cytopathology Unit ††Department of Medicine (DIMED), Endocrinology Unit ∥Department of Statistics, University of Padua, Padova Divisions of ‡Pathology **Endocrinology, University of Florence at Careggi Hospital, Firenze Divisions of §Endocrinology ¶Pathology, Niguarda Ca' Granda Hospital, Milano #Department of Pathology and Molecular Genetics, General Hospital, Treviso ‡‡Department of Medical Oncology, University of Brescia, Italy.
The reticulin algorithm (RA) offers improved diagnostic reproducibility for adrenocortical carcinoma (ACC) compared to the Weiss Score (WS). This staining technique demonstrates high interobserver agreement, aiding in accurate ACC diagnosis.
Area of Science:
- Pathology
- Oncology
- Histopathology
Background:
- The Weiss Score (WS) for adrenocortical carcinoma (ACC) diagnosis has limitations in reproducibility and application to borderline cases and variants.
- Existing diagnostic criteria require improvement for accurate classification of adrenocortical tumors.
Purpose of the Study:
- To validate the interobserver reproducibility of the reticulin algorithm (RA) for diagnosing adrenocortical tumors.
- To compare the diagnostic performance of the RA with the established Weiss Score (WS).
Main Methods:
- A series of 245 adrenocortical tumors (61 adenomas, 184 carcinomas) were evaluated by eight pathologists using reticulin staining.
- The reticulin algorithm (RA), based on reticulin framework alterations and specific parameters (necrosis, mitotic rate, vascular invasion), was applied.
- Interobserver agreement was assessed before and after a training session, with a second evaluation 10 weeks later.
Main Results:
- The RA reclassified 27% of cases, with 73% classified as carcinomas.
- Complete interobserver agreement (8/8 pathologists) was achieved in 75% of cases (κ=0.702), improving to 86% after training.
- High agreement was maintained across different case origins, pathologist experience levels, and histologic variants.
Conclusions:
- Reticulin staining is a reliable and easily interpretable technique for adrenocortical tumors.
- The reticulin algorithm (RA) demonstrates high interobserver reproducibility, supporting its use as a diagnostic method for adrenocortical carcinoma (ACC).
- The RA offers a valuable alternative or adjunct to the Weiss Score (WS) for improving ACC diagnosis.
