The renal histopathology in systemic vasculitis: An international survey study of inter- and intra-observer agreement
The renal histopathology in systemic vasculitis: An international survey study of inter- and intra-observer agreement
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DOI：
10.1093/oxfordjournals.ndt.a027086
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发表时间：
1996-10-01
影响因子：
6.1
通讯作者：
Bruijn, JA
中科院分区：
文献类型：
--
作者：
Bajema, IM;Hagen, EC;Bruijn, JA
为了将系统性血管炎的肾脏组织病理学结果与肾脏结局联系起来，需要对各种形态学参数进行评分。因此，我们进行了一项标准化研究，以评估系统性血管炎患者的肾活检。来自四个欧洲中心的四名经验丰富的肾脏病理学家参加了这项研究。设计了一个评分方案，要求观察者对大量的组织病理学病变进行定量（占肾小球总数的百分比）或二分法（存在/不存在量表）评分。由所有观察者对20份肾活检进行单独评分，分析观察者间的变异性。再次对随机选择的10份活检进行评分，以获得观察者内变异性。对于观察者间一致性，两轮定量变量的评价均令人满意（分别为0.55小于或等于肯德尔W小于或等于0.95和0.59小于或等于W小于或等于0.96，所有P < 0.05）。然而，观察者间二分数据的一致性较差（两轮中超过一半的参数kappa小于或等于0.30）。此外，观察者内一致性数据显示，定量数据分析的结果（两轮中超过85%的变量Pearson r > 0.45）优于二分评分系统（超过一半的变量kappa小于或等于0.30）。可以得出结论，即使是经验丰富的肾脏病理学家之间的差异发生在评分肾活检。如果采用定量方法审查活检，要求观察者对组织标本进行系统评分，则观察者间和观察者内的一致性更高。
In order to relate histopathological findings of the kidney in systemic vasculitis to renal outcome, scoring of various morphological parameters is necessary. Therefore, we conducted a standardization study for evaluating renal biopsies from patients with systemic vasculitis. Four experienced renal pathologists from four European centres joined in the study. A scoring protocol was devised that required the observers to score an extensive number of histopathological lesions either quantitatively (as a percentage of the total number of glomeruli) or dichotomously (on a present/absent scale). Twenty renal biopsies were scored individually by all the observers, from which the inter-observer variability was analysed. Ten randomly chosen biopsies were scored again, in order to obtain the intra-observer variability. For inter-observer agreement, the evaluation of the quantitative variables was satisfactory for both rounds (0.55 less than or equal to Kendall's W less than or equal to 0.95 and 0.59 less than or equal to W less than or equal to 0.96, respectively, with all P < 0.05). However, the inter-observer agreement for the dichotomous data was poor (kappa less than or equal to 0.30 in more than half of the parameters in both rounds). Also the data on intra-observer agreement showed more favourable results for the analysis of the quantitative data (Pearson's r > 0.45 in more than 85% of the variables in both rounds) than for the dichotomous scoring system (kappa less than or equal to 0.30 in more than half of the variables). It is concluded that even between experienced renal pathologists discrepancies occur in scoring kidney biopsies. Inter- and intra-observer agreement is greater if a quantitative method for reviewing the biopsies is applied that requires the observers to score the tissue specimens systematically.