229 Reproducibility study on invasiveness of pulmonary AdC with a modified classification analysis (RFS and OS) for cases categorized if ≥ 21 pathologists scored invasion as ‘yes’ and else ‘no’ (a score of “not sure” is left out) is shown in Table 6. Table 6. Survival analysis for cases categorized if >= 21 pathologists scored invasion as ‘Yes’ and else ‘No’ for rounds 1 and 2. RFS = relapse free survival; OS = overall survival. Round Invasion* n 5-year RFS p-value 5-year OS p-value 1 no 4 100% [n.e.] 0,32 100% [n.e.] 0,29 yes 66 79.3% [69.3 - 89.4%] 76.7% [66.3 - 87.1%] 2 no 15 100% [n.e.] 0,12 100% [n.e.] 0,021 yes 55 75.2% [ 63.4 - 87.0%] 72.2% [60.2 - 84.2%] Note an increase from 4 in the 1st round to 15 cases in the 2nd round, all with a 100% RFS and OS for cases categorized as “no invasion”. Thus, the consensus ability to identify cases which do not recur was improved following the first tutorial. The variation in assessment of pT stage, determined by invasive size, is shown in Table 7. In four out of 70 cases pT staging showed unanimous agreement. In 34 cases (49%) stage assignments were divided between pTis (adenocarcinomas in situ) and pT1. For invasive tumors an overlap between two adjacent pT categories may be explained if a total tumor size is relatively close to the adjacent category. However, this argument does not hold in cases that span more than two invasive categories. Table 7. Variation of pT stage distributions (based on invasive size only) within a case is shown for the all 3 rounds. pTis = pathology tumor staging (pT) for adenocarcinoma in situ; pT1a invasive adenocarcinoma ≤ 1 cm; pT1b >1 - ≤2cm; pT1c: >2- ≤3m. pT-stage round 1 round 2 round 3 pTis 0 0 1 pT1a 2 3 5 pT1b 6 5 5 pTis+pT1a 7 10 7 pTis+pT1a+pT1b 21 19 14 pTis+pT1a+pT1b+pT1c 4 4 3 pT1a+pT1b 23 22 27 pT1b+pT1c 4 4 5 pT1a+pT1b+pT1c 3 3 3 The viewing time for the three stainings is shown in Table 8. There is an increase in the 2nd round compared to the 1st round for viewing of elastin and CK7 staining. 15
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