International variation in the interpretation of renal transplant biopsies: Report of the CERTPAP Project
International variation in the interpretation of renal transplant biopsies: Report of the CERTPAP Project
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DOI：
10.1046/j.1523-1755.2001.00030.x
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发表时间：
2001-11-01
影响因子：
19.6
通讯作者：
Taub, N
中科院分区：
文献类型：
--
作者：
Furness, PN;Taub, N
背景Banff肾移植病理学工作公式旨在具有国际应用。仍有必要制定方法，以协调各实验室之间采用这种分级制度。班夫等级并不总是允许做出精确的管理决策。已经设计了用于诊断急性排斥反应的替代方案，但是还没有不同方法的独立测试。来自55例肾移植活检的切片在欧洲肾移植病理学评估程序（CERTPAP）项目的22个主要移植单位的实验室中循环。参与的病理学家被要求对32种不同的组织学特征进行分级，没有任何临床信息。每次分发五个案例后，向参与者提供反馈意见。寻求观察者间变异改善的统计学证据。研究结束时，寻找与原始临床病理诊断的相关性。结果。观察者间的差异大于以前报道的。对于研究的每一个特征，一些病理学家总是低估或高估。有相对较少的证据表明，作为反馈系统的结果，观察者间的变化有所改善。没有一个单一的特征允许急性排斥反应的可靠诊断。将Banff和CCTT模式应用于组织学分级显示出两种系统都没有明显的诊断优势，但是一个简单的基于计算机的推理网络，它结合了来自12个组织学特征的数据，执行了两种方法。在研究的“协议”活检中，长期生存与“急性”组织学特征的相关性优于与“慢性”组织学特征的相关性。这些结果并不会削弱班夫分类的价值，但它们表明在机构之间转换活检结果时需要谨慎。显然，多中心试验中的活检评价必须在一个中心进行。在个别病人的管理，需要解释班夫等级在当地的经验和临床信息的光强调。
Background. The Banff working formulation of renal transplant pathology is intended to have international application. There remains a need to develop methods to harmonize the application of such grading systems between laboratories. Banff grades do not always permit precise management decisions to be made. Alternative schemes have been devised for the diagnosis of acute rejection, but there have been no independent tests of the different approaches.Methods. Sections from 55 renal transplant biopsies were circulated around the laboratories of 22 major transplant units for the Convergence of European Renal Transplant Pathology Assessment Procedures (CERTPAP) Project. Participating pathologists were asked to grade 32 different histological features, without any clinical information. After each circulation of five cases, feedback was provided to participants. Statistical evidence of improvement in interobserver variation was sought. At the end of the study, correlations with the original clinicopathological diagnosis were sought.Results. Interobserver variation was greater than has previously been reported. For every feature studied, some pathologists consistently under-grade or over-grade. There was relatively little evidence of improvement in interobserver variation as a result of the feedback system. No single feature permitted a reliable diagnosis of acute rejection. Applying the Banff and CCTT schemas to the histological grades showed no clear diagnostic advantage for either system, but a simple computer-based inference network, which combined data from 12 histological features, out performed either approach. Within the "protocol" biopsies studied, long-term survival correlated better with "acute" than with "chronic" histological features.Conclusions. These results do not undermine the value of the Banff classification, but they demonstrate a need for caution when translating biopsy results between institutions. It is obvious that evaluation of biopsies in multicenter trials must be done in one center. In the management of individual patients, the need to interpret Banff grades in the light of local experience and clinical information is stressed.