REPORTING CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) - INTRAPATHOLOGIST AND INTERPATHOLOGIST VARIATION AND FACTORS ASSOCIATED WITH DISAGREEMENT
REPORTING CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) - INTRAPATHOLOGIST AND INTERPATHOLOGIST VARIATION AND FACTORS ASSOCIATED WITH DISAGREEMENT
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DOI：
10.1111/j.1365-2559.1990.tb01141.x
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发表时间：
1990-04-01
期刊：
影响因子：
6.4
通讯作者：
NEWCOMBE, R
中科院分区：
文献类型：
--
作者：
ISMAIL, SM;COLCLOUGH, AB;NEWCOMBE, R
来自不同医院的八位组织病理学家，他们先前检查了100例连续的阴道镜宫颈活检，并将初步研究的结果分发给了他们。然后，切片被“重新设盲”，并由病理学家重新检查，他们像以前一样，将它们分配到六个诊断类别中的一个。返回可用回答的7名观察员的病理学家间一致性程度通过kappa统计进行表征，并与先前研究中相同观察员的相应数字进行比较。尽管一些观察者在诊断实践中表现出显著的改变，但CIN 1和2的一致性持续较差，CIN 3的一致性中等，浸润性癌的一致性极好。对于每一个诊断类别，观察者内一致性始终优于观察者间一致性。观察者之间的观察者内变异程度存在显著差异。其中一位作者对20例分歧最大的病例进行了重新检查，并将其与20例分歧较小的活检进行了比较。不一致被认为与多种组合的绚丽乳头状瘤病毒变化、基底细胞增生和严重炎症相关。根据这些发现，我们建议改变CIN病变的术语。
Eight histopathologists, based at different hospitals, who had previously examined 100 consecutive colposcopic cervical biopsies were circulated with the results of the initial study. The slides were then ''reblinded'' and reexamined by the pathologists who, as before, assigned them into one of six diagnostic categories. The degree of interpathologist agreement for the seven observers who returned usable responses was characterized by kappa statistics and compared to the corresponding figures for the same observers from the previous study. Although some of the observers showed significant alterations in their diagnostic practices there was persistent poor agreement for CIN 1 and 2, mediocre agreement for CIN 3 and excellent agreement for invasive carcinoma. Intraobserver agreement was consistently better than interobserver agreement for each of the diagnostic categories. Significant differences were found among observers in the degree of intra-observer variability. The 20 cases in which there was most disagreement were re-examined by one of the authors who compared these with 20 biopsies which caused little disagreement. Disagreent was considered to be associated with florid papillomavirus changes, basal cell hyperplasia and severe inflammation in varying combinations. On the basis of these findings we suggest changes in the terminology of CIN lesions.