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Separation of Benign vs Malignant Adrenal Cortical Tumors Based on the Modified Weiss Score of Aubert et al

Purpose: To decide if a tumor of the adrenal cortex is benign or malignant based on the modification of the Weiss score proposed by Aubert et al.

Description

Aubert et al developed a diagnostic score based on the variables proposed by Weiss et al for separating benign and malignant adrenal cortical tumors. The goal was to improve the reliability of the score by using only the most reliable indicators. The authors are from Lille, France.


Parameters:

(1) mitotic rate per 50 high power fields (using the 40x objective lens)

(2) cytoplasm (percent clear cells)

(3) abnormal mitoses, with an excessive number of mitotic spindles or an abnormal distribution of chromosomes

(4) necrosis involving confluent nests of cells

(5) capsular invasion

 

Parameter

Finding

Points

mitotic rate

<= 5 in 50 high power fields

0

 

> 5 in 50 high power fields

2

percent clear cells (cytoplasm)

> 25%

0

 

<= 25%

2

abnormal mitoses

absent

0

 

present

1

necrosis

absent

0

 

present

1

capsular invasion

absent

0

 

present

1

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 7

 

Total Score

Diagnosis

0 or 2

benign

>= 3

malignant

 

 

Parameter

Threshold for Malignancy

Sensitivity

Specificity

tumor weight in grams

>= 50 g

100%

90.9%

tumor size in centimeters

>= 6.5 cm

100%

91.7%

mitotic rate

>= 5 per 50 hpf

96%

100%

MIB-1 labeling

>= 4%

95.7%

91.7%

modified Weiss score

>= 3

100%

96%

from Table 3, page 1617

 

where:

• MIB-1 staining reflects the percent of tumor nuclei that stain, using the Immunotech (Marseille, France) protocol. Counting is performed in areas with the greatest labeling density, with at least 1,000 cells counted from at least 10 random high power (x100 oil objective) fields.


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Specialty

Objective

ICD-10