Mudhar, Hardeep Singh, Krishna, Yamini 
ORCID: 0000-0001-5067-3682, Cross, Simon, Auw-Haedrich, Claudia, Barnhill, Raymond, Cherepanoff, Svetlana, Eagle, Ralph, Farmer, James, Folberg, Robert, Grossniklaus, Hans et al (show 9 more authors)
(2024)
A Multicenter Study Validates the WHO 2022 Classification for Conjunctival Melanocytic Intraepithelial Lesions With Clinical and Prognostic Relevance.
Laboratory investigation; a journal of technical methods and pathology, 104 (1).
100281-.
Abstract
Several nomenclature and grading systems have been proposed for conjunctival melanocytic intraepithelial lesions (C-MIL). The fourth "WHO Classification of Eye Tumors" (WHO-EYE04) proposed a C-MIL classification, capturing the progression of noninvasive neoplastic melanocytes from low- to high-grade lesions, onto melanoma in situ (MIS), and then to invasive melanoma. This proposal was revised to the WHO-EYE05 C-MIL system, which simplified the high-grade C-MIL, whereby MIS was subsumed into high-grade C-MIL. Our aim was to validate the WHO-EYE05 C-MIL system using digitized images of C-MIL, stained with hematoxylin and eosin and immunohistochemistry. However, C-MIL cases were retrieved from 3 supraregional ocular pathology centers. Adequate conjunctival biopsies were stained with hematoxylin and eosin, Melan-A, SOX10, and PReferentially expressed Antigen in Melanoma. Digitized slides were uploaded on the SmartZoom platform and independently scored by 4 ocular pathologists to obtain a consensus score, before circulating to 14 expert eye pathologists for independent scoring. In total, 105 cases from 97 patients were evaluated. The initial consensus diagnoses using the WHO-EYE04 C-MIL system were as follows: 28 benign conjunctival melanoses, 13 low-grade C-MIL, 37 high-grade C-MIL, and 27 conjunctival MIS. Using this system resulted in 93% of the pathologists showing only fair-to-moderate agreement (kappa statistic) with the consensus score. The WHO-EYE05 C-MIL system (with high-grade C-MIL and MIS combined) improved consistency between pathologists, with the greatest level of agreement being seen with benign melanosis (74.5%) and high-grade C-MIL (85.4%). Lowest agreements remained between pathologists for low-grade C-MIL (38.7%). Regarding WHO-EYE05 C-MIL scoring and clinical outcomes, local recurrences of noninvasive lesions developed in 8% and 34% of the low- and high-grade cases. Invasive melanoma only occurred in 47% of the cases that were assessed as high-grade C-MIL. This extensive international collaborative study is the first to undertake a comprehensive review of the WHO-EYE05 C-MIL scoring system, which showed good interobserver agreement and reproducibility.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Melanocytes, Humans, Melanoma, Skin Neoplasms, Melanosis, Hematoxylin, Eosine Yellowish-(YS), Prognosis, Reproducibility of Results, World Health Organization, Multicenter Studies as Topic |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 22 Nov 2023 16:15 |
| Last Modified: | 01 Mar 2024 15:38 |
| DOI: | 10.1016/j.labinv.2023.100281 |
| Open Access URL: | https://doi.org/10.1016/j.labinv.2023.100281 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3176972 |
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