Poor agreement in recognition of abnormal mitoses: requirement for standardized and robust definitions
Poor agreement in recognition of abnormal mitoses: requirement for standardized and robust definitions
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DOI：
10.1046/j.1365-2559.2001.01034.x
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发表时间：
2001-01-01
期刊：
影响因子：
6.4
通讯作者：
Kay, EW
中科院分区：
文献类型：
--
作者：
Barry, M;Sinha, SK;Kay, EW
目的：核分裂异常是鉴别良恶性肿瘤的一个有用特征，对某些肿瘤的预后有重要意义。由于组织病理学变量的使用受到其识别可重复性的限制，我们测试了组织病理学家之间异常有丝分裂分类的观察者间一致性。方法和结果：向10名执业组织病理学家展示了30个潜在的有丝分裂像，并要求将其归类为“正常有丝分裂”，根据每个病理学家在其常规实践中使用的标准，确定“异常有丝分裂”或“无丝分裂”。使用Kappa统计分析结果。总体一致性仅为一般，合并kappa值为0.31，30个供试品中仅4个被一致分类，无一被称为异常。“有丝分裂异常”类别的结果最差，仅轻微一致（kappa值0.19）。其他类别的一致性从中度到中度不等（kappa = 0.45）“非有丝分裂”为一般（kappa = 0.26）对于“正常有丝分裂”，观察者对结果的比较表明，对于45个可能配对中的12个，没有比单独偶然预期的一致性更高，结论：执业组织病理学家在识别异常有丝分裂方面的一致性较差。如果在瘤形成的背景下发现异常有丝分裂具有诊断和预后意义，则需要一个标准化和可靠的定义。
Aims: The finding of abnormal mitoses is a helpful feature in differentiating between benign and malignant neoplasia and has prognostic significance for some tumours. As the use of a histopathological variable is limited by the reproducibility of its recognition, we tested the interobserver agreement in the classification of abnormal mitoses among histopathologists.Methods and results: Ten practising histopathologists were shown 30 potential mitotic figures and were asked to classify these as 'normal mitoses','abnormal mitoses' or 'not mitoses' according to the criteria each pathologist used in their routine practice. The results were analysed using kappa statistics. Overall agreement was only fair with a combined kappa of 0.31 and there was unanimous categorization of only four of 30 test items, none of which as called abnormal, The poorest result was obtained for the category 'abnormal mitosis' with only slight agreement (kappa 0.19). Agreement for the other categories varied from moderate (kappa = 0.45) for 'not a mitosis' to fair (kappa = 0.26) for 'normal mitosis', Comparison of the results for observer pairs showed that for 12 out of the 45 possible pairings, there was no more agreement than might be expected by chance alone,Conclusion: Agreement is poor among practising histopathologists in the recognition of abnormal mitoses. A standardized and robust definition is needed if diagnostic and prognostic significance is accorded to the finding of an abnormal mitosis in the context of neoplasia.