Inter- and intra-observer variability in the classification of extracapsular extension in p16 positive oropharyngeal squamous cell carcinoma nodal metastases

James S. Lewis, Yaman Tarabishy, Jingqin Luo, Haresh Mani, Justin A. Bishop, Marino E. Leon, Manju L. Prasad, Haodong Xu, Silvana Di Palma

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Summary Objective Discern inter- and intra-observer variability in the classification of extracapsular extension (ECE) in p16+ oropharyngeal (OP) SCC comparing pathologists' own criteria versus those of a well-defined classification system. Methods Five pathologists reviewed 50 digitally scanned nodal metastasis slides in three Rounds. Round One was by their own criteria as ECE present or absent, and Rounds Two and Three were with a defined ECE system: Grade 0 (no ECE), 0c (no ECE - thick capsule; no infiltration), 1 (ECE - cells beyond capsule), and 2 (soft tissue metastasis - cells in soft tissue without residual node). Round Three assessed intra-observer variability after an 8 month washout period. Results In Round One, all five agreed on only 48% of cases (n = 24). Fleiss's Kappa value was 0.508 (95% CI: 0.357-0.644). For Rounds Two and Three, Grades 0 and 0c and Grades 1 and 2 were separately grouped as ECE absent or present. In Round Two, all five agreed on 68% of cases (n = 34). Fleiss' Kappa was 0.635 (95% CI: 0.472-0.783), indicating statistically significantly better agreement. In Round Three, all five agreed on 64% of cases (n = 32) giving a Fleiss's Kappa of 0.639. Pathologists agreed with their prior reads in approximately 90% of cases (average n = 45.4, range n = 42-49), an average intra-observer Cohen's Kappa of 0.8 (range: 0.68-0.95). Inter- and intra-observer variability rates for classification of soft tissue metastasis (ECE2) were substantially worse. Conclusion There is substantial inter-, and modest intra-, observer variability among head and neck pathologists for ECE in p16+ OPSCC, which is modestly improved by a defined system.

Original languageEnglish
Pages (from-to)985-990
Number of pages6
JournalOral Oncology
Volume51
Issue number11
DOIs
StatePublished - Nov 2015

Keywords

  • Extracapsular extension
  • Inter-observer variability
  • Lymph node metastasis
  • Oropharyngeal squamous cell carcinoma
  • Soft tissue metastasis
  • p16

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