Abstract
Objective: To determine the status of histopathological diagnosis of minimal deviation adenocarcinoma (MDA), i.e., adenoma malignum, and to see if replicable, clinically useful differential diagnosis is possible between MDA and lobular endocervical glandular hyperplasia (LEGH).
Study Design: Four gynecological pathologists independently diagnosed 52 cervical glandular proliferative lesions based on their own criteria. Based on common criteria, 7 gynecological pathologists diagnosed 44 cervical glandular lesions into LEGH, LEGH+adenocarcinoma in situ (AIS), MDA, and common adenocarcinoma. Interobserver agreement was evaluated by κ statistics.
Results: In the first study, interobserver agreement was slight (κ=0.115), and 5-year survival of patients with MDA varied from 13% to 60% among observers. In the second study, interobserver agreement improved to be substantial (κ=0.618), and the level between invasive lesions (MDA and common adenocarcinoma) and noninvasive lesions (LEGH and LEGH + AIS) was almost perfect (κ=0.928). Five-year survival was 100% for noninvasive lesions and 54% for invasive lesions (p<0.01).
Conclusions: Replicable, clinically meaningful differential diagnosis was possible between LEGH, LEGH with AIS, and MDA. Expansion of criteria and their application to preoperative diagnosis could prove to be very useful.
