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Histopathologic Assessment of Capsular Invasion in Follicular Thyroid Neoplasms—an Observer Variation Study

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Abstract

The assessment of capsular invasion is an essential but challenging step in the diagnosis of encapsulated follicular thyroid neoplasms. Therefore, interobserver agreement in the assessment of capsular invasion in these tumors was investigated among 11 thyroid pathologists by using virtual slides of 20 cases in which the original diagnosis considered the differential diagnosis of definite capsular invasion versus questionable capsular invasion. The assessment of capsular invasion was divided into three categories: (1) non-invasive, (2) questionable invasive, and (3) clear-cut invasive. The interobserver agreements for clear-cut invasive and non-invasive categories were fair (Kappa value = 0.578 and 0.404, respectively), whereas agreement for the questionable invasion was poor (Kappa value = 0.186). Disagreements in the assessment of invasion resulted in variable final pathological diagnoses. For example, the agreement for a diagnosis of malignancy was only fair (Kappa value = 0.545). Moreover, pathologists did not have a uniform approach for rendering a final diagnosis in cases with questionable capsular invasion, though nine of 11 pathologists did use the follicular tumor of uncertain malignant potential diagnosis as proposed by the World Health Organization classification of endocrine organs published in 2017. In conclusion, this study revealed considerable interobserver variation in the evaluation of capsular invasion, especially in follicular neoplasms with questionable invasion.

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Authors and Affiliations

  1. Department of Pathology, JiangYuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China

    Yun Zhu

  2. Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China

    Yaqiong Li

  3. Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Chan Kwon Jung

  4. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Dong Eun Song

  5. Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Jen-Fan Hang & Chiung-Ru Lai

  6. Department of Pathology, Qilu Hospital of Shandong University, Shandong, China

    Zhiyan Liu

  7. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Deepali Jain

  8. Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan

    Mitsuyoshi Hirokawa

  9. Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Wake-cho 4-5-1, Izumi, Osaka, 594-0073, Japan

    Kennichi Kakudo

  10. Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan

    Andrey Bychkov

  11. Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Andrey Bychkov

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  1. Yun Zhu
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Correspondence to Kennichi Kakudo.

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Zhu, Y., Li, Y., Jung, C.K. et al. Histopathologic Assessment of Capsular Invasion in Follicular Thyroid Neoplasms—an Observer Variation Study. Endocr Pathol 31, 132–140 (2020). https://doi.org/10.1007/s12022-020-09620-7

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