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- 病例学习（Number 22）
欢迎讨论：
1.输卵管原位癌是否是卵巢浆液性癌的前期病变？（一直以来这么认为）
2.在输卵管上皮不典型增生到原位癌这一个诊断过程中病理医生如何把握？
免疫组化在这一过程是否起作用？
3.再者，在临床实践过程中，遇到输卵管浆液癌，卵巢浆液性癌，子宫内膜浆液性癌，病理医生如何把握哪个到底是原发？如何向临床交代这一问题？
4.欢迎大家讨论，由于文章内容太大，无法上传，有感兴趣的同道留下邮箱给我，将原文发送一起讨论
Diagnosis of Serous Tubal Intraepithelial Carcinoma Based on Morphologic and Immunohistochemical
Features: A Reproducibility Study (Am J Surg Pathol 2011;35:1766–1775)
Abstract: There is compelling evidence that serous tubal
intraepithelial carcinoma (STIC) is a precursor of high-grade
serous ovarian carcinoma. Large-scale studies are now required
to determine its biological significance and clinical implication.
Before conducting these studies, a reproducible classification for
STIC is needed, and that is the goal of this study. This study
involved 6 gynecologic pathologists from 4 academic institutions
and 3 independent rounds of review. In round 1, sixty-seven
lesions ranging from normal, atypical, to STICs were classified by
5 pathologists on the basis of predetermined morphologic criteria.
Interobserver agreement for the diagnosis of STIC versus not
STIC was fair [k=0.39; 95%confidence interval (CI) 0.26, 0.52],
and intraobserver reproducibility ranged from fair to moderate
on the basis of percentage agreement and k. Round 2 involved
testing revised criteria that incorporated morphology and
immunohistochemistry (IHC) for p53 protein expression and
Ki-67 labeling in 10 sets by 3 of the pathologists. The result was
an improvement in interobserver agreement for the classification
of STIC (k=0.62; 95% CI 0.18, 1.00). An algorithm was then
created combining morphology and IHC for p53 and Ki-67, and
reproducibility was assessed as part of round 3. In 37 lesions
reviewed by 6 pathologists, substantial agreement for STIC versus
no STIC was observed (k=0.73; 95% CI 0.58, 0.86). In
conclusion, we have developed reproducible criteria for the
diagnosis of STIC that incorporate morphologic and IHC
markers for p53 and Ki-67. The algorithm we propose is expected
to help standardize the classification of STIC for future studies
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