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Grading of Medullary Thyroid Carcinoma: an Interobserver Reproducibility Study

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Abstract

Grade, based on proliferative activity and tumor necrosis, has recently been shown to be prognostic in medullary thyroid carcinoma (MTC) in multivariate analysis. The aim of this study was to evaluate the interobserver reproducibility of assessed grade in MTC. Three groups (each group included one resident/fellow and one attending pathologist) independently evaluated a cohort of 44 sporadic MTC. For each case, all available tumor slides were reviewed, and mitotic count and the presence of tumor necrosis were recorded. Ki-67 was performed, and the Ki-67 proliferative index was determined in the area of highest proliferative activity. Tumors were graded according to the recently published International Medullary Thyroid Carcinoma Grading System (IMTCGS). Kappa statistics were calculated for each individual criterion (mitotic count, Ki-67 proliferative index, and necrosis) and for assigned IMTCGS grade. For our cohort of 44 MTCs, the kappa statistic for mitotic count, Ki-67 proliferative index, and necrosis was 0.68, 0.86, and 0.89, respectively. The kappa statistic for assigned IMTCGS grade was 0.87. Our findings indicate that there was a strong level of agreement for assessment of grade in our cohort of MTC, indicating that grade as assessed by the IMTCGS is not only prognostic but also reproducible.

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Data Availability

All data generated or analyzed during this study are included in this published article.

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Author information

Author notes

  1. Jessica F. Williams and Melissa Zhao equally contributed to the study.

Authors and Affiliations

  1. Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Jessica F. Williams, Melissa Zhao, Fedaa Najdawi, Jason L. Hornick, Kristine S. Wong & Justine A. Barletta

  2. Division of Endocrinology, Brigham and Women’s Hospital, Boston, MA, USA

    Sara Ahmadi

  3. Harvard Medical School, Boston, MA, USA

    Jessica F. Williams, Melissa Zhao, Fedaa Najdawi, Sara Ahmadi, Jason L. Hornick, Kristine S. Wong & Justine A. Barletta

Authors
  1. Jessica F. Williams
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  2. Melissa Zhao
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  3. Fedaa Najdawi
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  7. Justine A. Barletta
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Contributions

JAB designed the study. FN, SA, and JAB acquired the clinicopathologic data. FN, JFW, MZ, KSW, JLH, and JAB performed the grading evaluation. JFW and MZ analyzed data, and JFW, MZ, and JAB interpreted the results. JFW and JAB wrote the manuscript. MZ, FN, KSW, and JLH edited the manuscript.

Corresponding author

Correspondence to Justine A. Barletta.

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Ethics Approval and Consent to Participate

Our study did not require ethical approval.

Conflict of Interest

F. Najdawi is currently employed at PathAI. All other authors have no conflicts of interest.

Disclosure

This study was presented at the 2022 USCAP meeting in Los Angeles on March 22, 2022.

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Williams, J.F., Zhao, M., Najdawi, F. et al. Grading of Medullary Thyroid Carcinoma: an Interobserver Reproducibility Study. Endocr Pathol 33, 371–377 (2022). https://doi.org/10.1007/s12022-022-09718-0

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