"Delayed Villous Maturation" in Placental Reporting: Concordance among Consultant Pediatric Pathologists at a Single Specialist Center
"Delayed Villous Maturation" in Placental Reporting: Concordance among Consultant Pediatric Pathologists at a Single Specialist Center
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DOI：
10.2350/12-02-1604-oa.1
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发表时间：
2015-09-01
影响因子：
1.9
通讯作者：
Weber, Martin A.
中科院分区：
文献类型：
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作者：
Al-Adnani, Mudher;Marnerides, Andreas;Weber, Martin A.
绒毛成熟延迟（DVM）与妊娠晚期不良妊娠结局（包括死产）的风险增加有关，但已发表的数据有限。此外，人们认识到，绒毛成熟的评估是主观的，并受到观察者内和观察者间差异的阻碍。本次稽查旨在评估单个专科中心儿科病理学家之间DVM报告的一致性，以提高这一潜在重要诊断的可重复性。这是对2013年6月至2013年12月期间提交进行组织病理学检查的妊娠35周或以上的单胎胎盘的回顾性审查。胎盘切片由4名儿科病理学家独立审查，除了胎龄外，对原始报告不知情;绒毛成熟评估为适当，加速或延迟规定的胎龄。共审查了464份胎盘组织病理学报告，其中164份大于35周妊娠;其中42份（26%）最初报告为DVM。在审核切片审查后，38例病例（23%）经至少1名病理学家评估显示DVM。只有14例病例（占所有审查病例的9%;所有病例的37%称为DVM）达成了至少3名病理学家同意DVM诊断的共识。然而，2名病理学家之间的总体一致率为0.92。DVM的一致性在病理学家中很差，并且受观察者间差异的影响。通过对所有考虑诊断为DVM的胎盘进行一致的组织学回顾和严格应用已发表的诊断标准，可以提高一致性。
Delayed villous maturation (DVM) has been associated with an increased risk of adverse pregnancy outcome, including stillbirth, in the late third trimester, but there are limited published data. Moreover, it is recognized that the assessment of villous maturation is subjective and hampered by both intraobserver and interobserver variability. This audit aims to assess concordance in the reporting of DVM among pediatric pathologists at a single specialist center to improve reproducibility of this potentially important diagnosis. This is a retrospective review of singleton placentas from pregnancies at 35 weeks gestation or greater submitted for histopathologic examination between June 2013 and December 2013. Placental slides were reviewed independently by 4 pediatric pathologists, blinded to the original report, apart from gestational age; villous maturation was assessed as appropriate, accelerated, or delayed for the stated gestational age. A total of 464 placental histopathology reports were reviewed, of which 164 were greater than 35 weeks gestation; of those, 42 (26%) were originally reported as DVM. Following the audit slide review, 38 cases (23%) were assessed to show DVM by at least 1 pathologist. Consensus, with at least 3 pathologists agreeing to a diagnosis of DVM, was achieved in only 14 cases (9% of all cases reviewed; 37% of all cases called DVM). However, the proportion of overall agreement between 2 of the pathologists was 0.92. Concordance for DVM is poor among pathologists and subject to much interobserver variability. Consistency may be improved by consensus histologic review of all the placentas in which the diagnosis of DVM is being considered and stringent application of the published diagnostic criteria.