OBSERVER VARIATION IN HISTOPATHOLOGICAL DIAGNOSIS AND GRADING OF CERVICAL INTRAEPITHELIAL NEOPLASIA
OBSERVER VARIATION IN HISTOPATHOLOGICAL DIAGNOSIS AND GRADING OF CERVICAL INTRAEPITHELIAL NEOPLASIA
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DOI：
10.1136/bmj.298.6675.707
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发表时间：
1989-03-18
影响因子：
105.7
通讯作者：
NEWCOMBE, RG
中科院分区：
文献类型：
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作者：
ISMAIL, SM;COLCLOUGH, AB;NEWCOMBE, RG
为了评估组织病理学家在诊断和分级宫颈上皮内瘤变方面的差异，8名来自不同医院的经验丰富的组织病理学家检查了同一组100例连续阴道镜宫颈活检标本，并将其分为6个诊断类别之一。这些是正常鳞状上皮、非肿瘤性鳞状增生、宫颈上皮内瘤变I、II和III级以及其他。给予组织病理学家目前公认的宫颈上皮内瘤样病变诊断和分级标准，并要求他们在提供的视觉线性模拟量表上标记其决策的置信度。组织病理学家之间的一致性程度通过kappa统计来表征，其显示总体一致性较差（未加权kappa 0.358）。观察者之间的一致性对于浸润性病变是极好的，对于宫颈上皮内瘤变III级是中等好的，对于宫颈上皮内瘤变I级和II级是差的（未加权kappa值分别为0.832、0.496、0.172和0.175）;所有宫颈上皮内瘤变级别的kappa值加在一起为0.660。最重要的分歧在于反应性鳞状细胞增生与宫颈上皮内瘤变I级的区别。组织病理学家对诊断宫颈上皮内瘤变III级和浸润性癌（其他）有信心，但对诊断宫颈上皮内瘤变I级和II级以及腺样囊性癌（其他）没有信心。经验丰富的组织病理学家在宫颈上皮内瘤变分级方面表现出相当大的观察者间差异，更重要的是在区分反应性鳞状细胞增生和宫颈上皮内瘤变I级方面。建议放弃宫颈上皮内瘤变的三级分类，而引入一个需要随访而不治疗的边界分类。
To assess the variability among histopathologists in diagnosing and grading cervical intraepithelial neoplasia eight experienced histopathologists based at different hospitals examined the same set of 100 consecutive colposcopic cervical biopsy specimens and assigned them into one of six diagnostic categories. These were normal squamous epithelium, non-neoplastic squamous proliferations, cervical intraepithelial neoplasia grades I, II, and III, and other. The histopathologists were given currently accepted criteria for diagnosing and grading cervical intraepithelial neoplasia and asked to mark their degree of confidence about their decision on a visual linear analogue scale provided. The degree of agreement between the histopathologists was characterised by kappa statistics, which showed an overall poor agreement (unweighted kappa 0.358). Agreement between observers was excellent for invasive lesions, moderately good for cervical intraepithelial neoplasia grade III, and poor for cervical intraepithelial neoplasia grades I and II (unweighted kappa 0.832, 0.496, 0.172, and 0.175, respectively); the kappa value for all grades of cervical intraepithelial neoplasia taken together was 0.660. The most important source of disagreement lay in the distinction of reactive squamous proliferations from cervical intraepithelial neoplasia grade I. The histopathologists were confident in diagnosing cervical intraepithelial neoplasia grade III and invasive carcinoma (other) but not as confident in diagnosing cervical intraepithelial neoplasia grades I and II and glandular atypia (other). Experienced histopathologists show considerable interobserver variability in grading cervical intraepithelial neoplasia and more importantly in distinguishing between reactive squamous proliferations and cervical intraepithelial neoplasia grade I. It is suggested that the three grade division of cervical intrapeithelial neoplasia should be abandoned and a borderline category introduced that entails follow up without treatment.