Original Article
Low Interobserver Agreement in Cytology Grading of Mucinous Pancreatic Neoplasms Carlie S. Sigel, MD1; Marcia Edelweiss, MD1; Leung Chu Tong, MD, FRCPC2; Joanna Magda, CT(ASCP), MPH1; Handy Oen, CT(ASCP)1; Keith M. Sigel, MD, MPH3; and Maureen F. Zakowski, MD1
BACKGROUND: Identifying high-grade features in patients with pancreatic mucinous neoplasms (MNs) is important for patient management. The reproducibility of MN cytology grading has been evaluated to a limited extent. In the current study, the authors evaluated interobserver variability in grading MNs and the identification of neoplastic mucin in endoscopic ultrasound-guided fine-needle aspiration specimens. METHODS: A 54-case grading set was created from histologically confirmed MNs (44 MNs) and nonmucinous lesions with abundant gastrointestinal contamination (10 nonmucinous lesions). Six observers received a tutorial, reviewed prescreened slides, and recorded: 1) a diagnosis according to a 6tiered system (TS) (nondiagnostic, atypical [ATP], mucinous cyst low grade [MCLG], mucinous cyst high grade, suspicious for adenocarcinoma, and positive for adenocarcinoma); 2) the cyst fluid carcinoembryonic antigen diagnosis (CEADX); and 3) the presence of neoplastic musin. Interobserver agreement (IOA) was evaluated by calculation of kappa coefficients (Kappa). Diagnostic accuracy was not evaluated. RESULTS: The IOA was lowest for the 6-TS (Kappa, 0.13; P
Low Interobserver Agreement in Cytology Grading of Mucinous Pancreatic Neoplasms Carlie S. Sigel, MD1; Marcia Edelweiss, MD1; Leung Chu Tong, MD, FRCPC2; Joanna Magda, CT(ASCP), MPH1; Handy Oen, CT(ASCP)1; Keith M. Sigel, MD, MPH3; and Maureen F. Zakowski, MD1
BACKGROUND: Identifying high-grade features in patients with pancreatic mucinous neoplasms (MNs) is important for patient management. The reproducibility of MN cytology grading has been evaluated to a limited extent. In the current study, the authors evaluated interobserver variability in grading MNs and the identification of neoplastic mucin in endoscopic ultrasound-guided fine-needle aspiration specimens. METHODS: A 54-case grading set was created from histologically confirmed MNs (44 MNs) and nonmucinous lesions with abundant gastrointestinal contamination (10 nonmucinous lesions). Six observers received a tutorial, reviewed prescreened slides, and recorded: 1) a diagnosis according to a 6tiered system (TS) (nondiagnostic, atypical [ATP], mucinous cyst low grade [MCLG], mucinous cyst high grade, suspicious for adenocarcinoma, and positive for adenocarcinoma); 2) the cyst fluid carcinoembryonic antigen diagnosis (CEADX); and 3) the presence of neoplastic musin. Interobserver agreement (IOA) was evaluated by calculation of kappa coefficients (Kappa). Diagnostic accuracy was not evaluated. RESULTS: The IOA was lowest for the 6-TS (Kappa, 0.13; P
