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Published on: September 15, 2023
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Inter-Observer Variation in the Pathologic Identification of Minimal Extrathyroidal Extension in Papillary Thyroid
Henry K Su1, Bruce M Wenig2, Grace C Haser1
11 Department of Otolaryngology-Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York.
Summary
Pathologist agreement on minimal extrathyroidal extension (mETE) in papillary thyroid carcinoma (PTC) is poor. This lack of consensus questions the utility of mETE in staging and treatment decisions for PTC.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Extrathyroidal extension (ETE) is a key prognostic factor in papillary thyroid carcinoma (PTC).
- Minimal extrathyroidal extension (mETE) involves sternothyroid muscle or perithyroid soft tissue, leading to pT3 upstaging.
- The prognostic significance and pathological identification of mETE remain controversial.
Purpose of the Study:
- To assess the inter-pathologist agreement in identifying minimal extrathyroidal extension (mETE) in papillary thyroid carcinoma (PTC).
- To explore the criteria used by pathologists for mETE diagnosis.
Main Methods:
- Eleven expert pathologists reviewed 69 scanned slides of PTC specimens.
- Pathologists evaluated slides for the presence of mETE and listed their diagnostic criteria.
Main Results:
- Overall agreement for mETE identification was slight (κ = 0.14).
- Moderate agreement was observed for skeletal muscle involvement (κ = 0.46), while agreement was slight for vascular invasion (κ = 0.02).
- Disagreement stemmed from varying interpretations and criteria for diagnosing mETE.
Conclusions:
- Poor inter-pathologist agreement exists for identifying mETE in PTC.
- Variations in interpretation and diagnostic criteria challenge the utility of mETE in PTC staging and treatment.
- Lack of concordance may explain controversies surrounding the prognostic significance of mETE.
