Stijn van Weert1, Isaäc van der Waal2, Birgit I Witte3, C René Leemans4, Elisabeth Bloemena2. 1. Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: s.vanweert@vumc.nl. 2. Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands. 3. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. 4. Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Histopathological grading of adenoid cystic carcinoma (ACC) is a controversial issue. It is generally agreed that solid type ACC has a relatively poor prognosis. However, the amount of solid regions within this often mixed type tumor that predicts a poor prognosis is not firmly established. Some authors stipulate that the presence of a solid component regardless of the amount is a poor prognosticator where others argue that the amount should be taken into consideration. Two grading systems most commonly used are those described by Perzin et al./Szanto et al. and Spiro et al., respectively. They report that prognosis of ACC is poor if >30% and >50% of the tumor volume has a solid growth pattern, respectively. MATERIAL AND METHODS: The described grading systems are applied to a series of 81 surgically treated cases of ACC at the VU University Medical Center, Amsterdam, The Netherlands. Moreover, we introduced an alternative grading system, in which the presence of a solid component, irrespective of its amount, is considered. All three systems of grading were tested for inter-observer concordance and prediction of prognosis. RESULTS: Inter-observer concordance for grading ACC according to Perzin et al./Szanto et al. and Spiro et al., proved to be moderate with Kappa Scores of 0.393 and 0.433, respectively. Our alternative grading system yielded inter-observer concordance with a Cohen's kappa result of 0.990. All systems were comparable in discriminating patients with poor clinical outcome. Histopathological grade proved to be an independent prognosticator. CONCLUSION: The presence of any solid component in ACC is a negative prognosticator, and can histopathologically be diagnosed with a high reliability. These results suggest to merely register the presence or absence of a solid tumor component since its inter-observer variability is very low, its reproducibility is high and its predictive value is comparable to the traditional grading systems used.
BACKGROUND: Histopathological grading of adenoid cystic carcinoma (ACC) is a controversial issue. It is generally agreed that solid type ACC has a relatively poor prognosis. However, the amount of solid regions within this often mixed type tumor that predicts a poor prognosis is not firmly established. Some authors stipulate that the presence of a solid component regardless of the amount is a poor prognosticator where others argue that the amount should be taken into consideration. Two grading systems most commonly used are those described by Perzin et al./Szanto et al. and Spiro et al., respectively. They report that prognosis of ACC is poor if >30% and >50% of the tumor volume has a solid growth pattern, respectively. MATERIAL AND METHODS: The described grading systems are applied to a series of 81 surgically treated cases of ACC at the VU University Medical Center, Amsterdam, The Netherlands. Moreover, we introduced an alternative grading system, in which the presence of a solid component, irrespective of its amount, is considered. All three systems of grading were tested for inter-observer concordance and prediction of prognosis. RESULTS: Inter-observer concordance for grading ACC according to Perzin et al./Szanto et al. and Spiro et al., proved to be moderate with Kappa Scores of 0.393 and 0.433, respectively. Our alternative grading system yielded inter-observer concordance with a Cohen's kappa result of 0.990. All systems were comparable in discriminating patients with poor clinical outcome. Histopathological grade proved to be an independent prognosticator. CONCLUSION: The presence of any solid component in ACC is a negative prognosticator, and can histopathologically be diagnosed with a high reliability. These results suggest to merely register the presence or absence of a solid tumor component since its inter-observer variability is very low, its reproducibility is high and its predictive value is comparable to the traditional grading systems used.
Authors: Bin Xu; Esther Drill; Allen Ho; Alan Ho; Lara Dunn; Carlos Nicolas Prieto-Granada; Timothy Chan; Ian Ganly; Ronald Ghossein; Nora Katabi Journal: Am J Surg Pathol Date: 2017-10 Impact factor: 6.394
Authors: Richard J Cassidy; Jeffrey M Switchenko; Mark W El-Deiry; Ryan H Belcher; Jim Zhong; Conor E Steuer; Nabil F Saba; Mark W McDonald; David S Yu; Theresa W Gillespie; Jonathan J Beitler Journal: Laryngoscope Date: 2018-09-08 Impact factor: 3.325
Authors: Dipti P Sajed; William C Faquin; Chris Carey; Eric A Severson; Amir H Afrogheh; Carl A Johnson; Stephen C Blacklow; Nicole G Chau; Derrick T Lin; Jeffrey F Krane; Vickie Y Jo; Joaquín J Garcia; Lynette M Sholl; Jon C Aster Journal: Am J Surg Pathol Date: 2017-11 Impact factor: 6.394
Authors: Sarah Atallah; Morgane Marc; Antoine Schernberg; Florence Huguet; Isabelle Wagner; Antti Mäkitie; Bertrand Baujat Journal: Cancer Manag Res Date: 2022-06-04 Impact factor: 3.602
Authors: Bin Xu; Ronald Ghossein; Alan Ho; Kartik Viswanathan; Anjanie Khimraj; Maelle Saliba; Jennifer R Cracchiolo; Nora Katabi Journal: Head Neck Date: 2021-04-24 Impact factor: 3.821