Reproducibility of the diagnosis of atypical endornetrial hyperplasia - A Gynecologic Oncology Group Study
Reproducibility of the diagnosis of atypical endornetrial hyperplasia - A Gynecologic Oncology Group Study
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DOI：
10.1002/cncr.21649
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发表时间：
2006-02-15
期刊：
影响因子：
6.2
通讯作者：
Gallup, DG
中科院分区：
文献类型：
--
作者：
Zaino, RJ;Kauderer, J;Gallup, DG
背景。大多数妇科医生根据目前国际妇科病理学家协会(ISGP)/世界卫生组织对子宫内膜增生的分类来确定治疗方法，其可重复性受到质疑。妇科肿瘤组（GOG）发起了一项方案，以评估激素治疗非典型子宫内膜增生的疗效。(AEH)。第一阶段（A部分）的主要目标是前瞻性地确定由3名妇科病理学家组成的小组对转诊机构病理学家诊断AEH的可重复性，并确定小组成员诊断的可重复性。该方案纳入了386名妇女，根据活检或刮除，由转诊机构的病理学家诊断为AEH。可用的幻灯片由3名妇科病理学家组成的小组独立评估和解释，他们使用国际妇科病理学家协会(ISGP) /世界卫生组织的标准。大多数诊断是基于3名小组成员中至少2名的诊断一致性。只有38%的病例支持转诊机构病理学家对AEH的诊断。AEH的整体kappa值为0.28。多数诊断为腺癌（29%），循环子宫内膜（7%）和非典型增生（18%）。在40%的病例中，所有3个专家组对任何诊断达成了一致意见。对于该小组，任何诊断的配对kappa值范围为0.34-0.43，总体kappa值为0.40。转诊机构的病理学家对AEH的诊断由一组妇科病理学家的可重复性很差。对病变严重程度的低估和高估都是很常见的。在这些标本中诊断AEH的亚专家小组成员的可重复性水平也很差。需要更好的标准和更好的采样来提高这种诊断的可重复性，特别是如果它要用于临床决策。
BACKGROUND. Most gynecologists determine therapy based on current International Society of Gynecologic Pathologists (ISGP)/World Health Organization classification of endometrial hyperplasia, the reproducibility of which has been questioned. The Gynecologic Oncology Group (GOG) initiated a protocol to assess the efficacy of hormonal therapy of atypical endometrial hyperplasia. (AEH). Primary goals of the first phase (Part A) were to prospectively determine reproducibility of referring institution's pathologist's diagnosis of AEH by a panel of 3 gynecologic pathologists and to determine reproducibility of diagnoses by panel members.METHODS. Three hundred six women were entered on this protocol with a referring institution's pathologist diagnosis of AEH based on biopsy or curettage. Available slides were assessed independently and interpreted by each of a panel of 3 gynecologic pathologists who used International Society of Gynecologic Pathologists (ISGP) /World Health Organization criteria. The majority diagnosis was based on diagnostic concordance by at least 2 of the 3 panelists.RESULTS. The referring institution's pathologist's diagnosis of AEH was supported by the majority of the panel in only 38% of cases. Overall kappa value for the panel diagnosis of AEH was 0.28. The majority diagnosis was adenocarcinoma in 29%, cycling endometrium in 7%, and nonatypical hyperplasia in 18% of cases. Unanimous agreement for any diagnosis was reached among all 3 of the panel in 40% of cases. For the panel, paired kappa values for any diagnosis ranged 0.34-0.43, with an overall kappa value of 0.40.CONCLUSION. Reproducibility of referring institution's pathologists' diagnosis of AEH by a panel of gynecologic pathologists is poor. Both underestimation and overestimation of the severity of the lesion are very common. The level of reproducibility among subspecialist panel members for diagnosis of AEH in these specimens also is poor. Better criteria and better sampling are needed to improve reproducibility of this diagnosis, particularly if it is to be used for clinical decisions.