Histopathological Identification of Colon Cancer with Microsatellite Instability

摘要: Cancer with high levels of microsatellite instability (MSI-H) is the hallmark hereditary nonpolyposis colorectal cancer syndrome, and MSI-H occurs in approximately 15% sporadic carcinomas that have improved prognosis. We examined utility histopathology for identification cancers by evaluating features 323 using specified criteria comparing results to status. Coded hematoxylin eosin sections were evaluated tumor (signet ring cells; mucinous histology; cribriforming, poor differentiation, medullary-type pattern; sponge-like growth; pushing invasive margin) host immune response (Crohn's-like lymphoid reaction, intratumoral lymphocytic infiltrate, intraepithelial T cells immunohistochemistry CD3 morphometry). Interobserver variation among five pathologists was determined. Subjective interpretation as an indication MSI testing recorded. found medullary carcinoma, lymphocytosis, differentiation best discriminators between microsatellite-stable (odds ratio: 37.8, 9.8, 4.0, respectively; P = 0.000003 < 0.000001) specificity (99 87%). The sensitivities, however, very low (14 38%), interobserver agreement good only evaluation (kappa, 0.69). Mucinous histopathological type presence signet had odds ratios 3.3 2.7 (P 0.005 0.02) specificities 95% but sensitivities 15 13%. overall suggesting performed better than any individual feature; ratio 7.5 sensitivity 49%, 89%, moderate 0.52). Forty CD3-positive lymphocytes/0.94 mm2, established receiver operating characteristic curve analysis, resulted 6.0 75% 67%. Our findings indicate can be used prioritize colon studies, morphological prediction has sensitivity, requiring molecular analysis therapeutic decisions.