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Abstract：
The World Health Organization incorporates morphologic features with prognostic significance in the 2021 classification of epithelioid diffuse pleural mesothelioma (E-DPM). Although cytology specimens are often the first and occasionally the only specimen available for patients with DPM, these features have not yet been investigated in cytology.
Nuclear atypia, pleomorphic features, necrosis, and architectural patterns were retrospectively assessed in 35 paired cytology and concurrent/consecutive surgical pathology specimens of E-DPM. Agreement between pairs was determined via unweighted κ scores. Discordant cases were re-reviewed to determine the reasons for disagreement.
Interpretation of nuclear atypia in cytology was concordant with histology in all cases (κ = 1.000; p < .001). The presence of pleomorphic features and necrosis was concordant in 97.1% (κ = 0.842; p < .001) and 85.7% (κ = 0.481; p = .001) of paired cases, respectively. Assessment of architectural patterns in cytology showed only slight agreement with histology (κ = 0.127; p = .037). In cytology cases (n = 23) with cell block material available, assessment of nuclear atypia and the presence of pleomorphic features showed perfect agreement (κ = 1.000; p < .001, each), the presence of necrosis showed moderate agreement (κ = 0.465; p = .008), and assessment of architectural patterns showed slight agreement (κ = 0.162; p = .15) in paired specimens. Most disagreements were due to sampling differences between cytology and histology specimens.
Although complete nuclear grading of E-DPM is not possible given the unreliability of mitotic counts in cytology, assessment of nuclear atypia in cytology specimens is shown to be reliable. Identification of pleomorphic features and necrosis is also reliable despite occasional sampling issues. Assessment of architectural patterns is more limited in cytology.
Nuclear atypia, pleomorphic features, necrosis, and architectural patterns were retrospectively assessed in 35 paired cytology and concurrent/consecutive surgical pathology specimens of E-DPM. Agreement between pairs was determined via unweighted κ scores. Discordant cases were re-reviewed to determine the reasons for disagreement.
Interpretation of nuclear atypia in cytology was concordant with histology in all cases (κ = 1.000; p < .001). The presence of pleomorphic features and necrosis was concordant in 97.1% (κ = 0.842; p < .001) and 85.7% (κ = 0.481; p = .001) of paired cases, respectively. Assessment of architectural patterns in cytology showed only slight agreement with histology (κ = 0.127; p = .037). In cytology cases (n = 23) with cell block material available, assessment of nuclear atypia and the presence of pleomorphic features showed perfect agreement (κ = 1.000; p < .001, each), the presence of necrosis showed moderate agreement (κ = 0.465; p = .008), and assessment of architectural patterns showed slight agreement (κ = 0.162; p = .15) in paired specimens. Most disagreements were due to sampling differences between cytology and histology specimens.
Although complete nuclear grading of E-DPM is not possible given the unreliability of mitotic counts in cytology, assessment of nuclear atypia in cytology specimens is shown to be reliable. Identification of pleomorphic features and necrosis is also reliable despite occasional sampling issues. Assessment of architectural patterns is more limited in cytology.
摘要：
背景：世界卫生组织在2021年上皮样弥漫性胸膜间皮瘤（E-DPM）的分类中纳入了具有预后意义的形态学特征。尽管细胞学标本通常是DPM患者可用的第一个标本，有时也是唯一的标本，这些特征尚未在细胞学中进行研究。
方法：核异型，多形性特征，坏死,在35个配对的细胞学和同时/连续的E-DPM手术病理标本中对结构模式进行了回顾性评估。通过未加权κ分数确定配对之间的一致性。重新审查了不一致的案件，以确定不一致的原因。
结果：在所有病例中，细胞学中细胞核异型性的解释与组织学一致（κ=1.000；p<.001）。在97.1％（κ=0.842；p<.001）和85.7％（κ=0.481；p=.001）的配对病例中，多形性特征和坏死的存在是一致的。分别。细胞学结构模式的评估显示与组织学仅略有一致性（κ=0.127；p=0.037）。在有细胞块材料的细胞学病例（n=23）中，核异型性的评估和多形性特征的存在显示出完美的一致性（κ=1.000;p<.001，每个），坏死的存在显示中等一致性（κ=0.465;p=.008），在配对标本中，对建筑模式的评估显示出轻微的一致性（κ=0.162；p=.15）。大多数分歧是由于细胞学和组织学标本之间的采样差异。
结论：尽管由于细胞学中有丝分裂计数的不可靠性，E-DPM的完整核分级是不可能的，细胞学标本中核异型性的评估被证明是可靠的。尽管偶尔出现采样问题，但多形性特征和坏死的识别也是可靠的。对建筑模式的评估在细胞学中更为有限。
方法：核异型，多形性特征，坏死,在35个配对的细胞学和同时/连续的E-DPM手术病理标本中对结构模式进行了回顾性评估。通过未加权κ分数确定配对之间的一致性。重新审查了不一致的案件，以确定不一致的原因。
结果：在所有病例中，细胞学中细胞核异型性的解释与组织学一致（κ=1.000；p<.001）。在97.1％（κ=0.842；p<.001）和85.7％（κ=0.481；p=.001）的配对病例中，多形性特征和坏死的存在是一致的。分别。细胞学结构模式的评估显示与组织学仅略有一致性（κ=0.127；p=0.037）。在有细胞块材料的细胞学病例（n=23）中，核异型性的评估和多形性特征的存在显示出完美的一致性（κ=1.000;p<.001，每个），坏死的存在显示中等一致性（κ=0.465;p=.008），在配对标本中，对建筑模式的评估显示出轻微的一致性（κ=0.162；p=.15）。大多数分歧是由于细胞学和组织学标本之间的采样差异。
结论：尽管由于细胞学中有丝分裂计数的不可靠性，E-DPM的完整核分级是不可能的，细胞学标本中核异型性的评估被证明是可靠的。尽管偶尔出现采样问题，但多形性特征和坏死的识别也是可靠的。对建筑模式的评估在细胞学中更为有限。
