Cancer treatment and research communications · 2025
Validation of the pheochromocytoma of adrenal gland scaled score (PASS) grading system: A retrospective double-centered cross-sectional study.
СтатьяМногоцентровое исследованиеВалидационное исследованиеОбзорНазвание и аннотация: Перевод в очереди
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Faraman Maha Ahmad, Albostani Ammar, Faraman Rufaida Ahmad, Al-Saleh Walid
Аннотация
BACKGROUND: Pheochromocytomas are adrenal medullary tumors with unpredictable malignant potential. The Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) stratifies risk based on histology, but its reliability is debated. This study evaluates PASS performance in a contemporary cohort.
METHODS: We retrospectively reviewed adrenal tumor archives from two tertiary hospitals (2014-2021). Among 286 adrenalectomies, 50 pheochromocytomas with complete clinical and histological data met inclusion criteria. Two pathologists independently applied the 12 PASS criteria; discrepancies were resolved by consensus. Tumors were classified as lower-risk (PASS <4) or higher-risk (PASS ≥4). Demographic and clinicopathologic data were analyzed and compared with published series.
RESULTS: Of 50 cases, 27 (54 %) were lower-risk and 23 (46 %) higher-risk. Groups did not differ significantly by age or sex, though both showed female predominance (∼70 %). Right-sided tumors were more common. Higher-risk tumors more frequently exhibited necrosis, capsular invasion, and mitotic activity, whereas these features were rare in lower-risk tumors. Subjective features such as pleomorphism demonstrated inter-observer variability. Compared with Thompson's original series, our patients were younger and had larger tumors.
CONCLUSION: PASS reliably identifies a low-risk subgroup, supporting its use as a screening tool to reduce unnecessary surveillance. However, its ability to predict malignant behavior is limited by subjective criteria and inter-observer variation. PASS should therefore be applied within a multimodal framework incorporating molecular markers. Prospective studies are needed to refine prognostic accuracy.
METHODS: We retrospectively reviewed adrenal tumor archives from two tertiary hospitals (2014-2021). Among 286 adrenalectomies, 50 pheochromocytomas with complete clinical and histological data met inclusion criteria. Two pathologists independently applied the 12 PASS criteria; discrepancies were resolved by consensus. Tumors were classified as lower-risk (PASS <4) or higher-risk (PASS ≥4). Demographic and clinicopathologic data were analyzed and compared with published series.
RESULTS: Of 50 cases, 27 (54 %) were lower-risk and 23 (46 %) higher-risk. Groups did not differ significantly by age or sex, though both showed female predominance (∼70 %). Right-sided tumors were more common. Higher-risk tumors more frequently exhibited necrosis, capsular invasion, and mitotic activity, whereas these features were rare in lower-risk tumors. Subjective features such as pleomorphism demonstrated inter-observer variability. Compared with Thompson's original series, our patients were younger and had larger tumors.
CONCLUSION: PASS reliably identifies a low-risk subgroup, supporting its use as a screening tool to reduce unnecessary surveillance. However, its ability to predict malignant behavior is limited by subjective criteria and inter-observer variation. PASS should therefore be applied within a multimodal framework incorporating molecular markers. Prospective studies are needed to refine prognostic accuracy.