Interobserver discrepancy using the 1998 World Health Organization/International Society of Urologic Pathology classification of urothelial neoplasms: Practical choices for patient care
Interobserver discrepancy using the 1998 World Health Organization/International Society of Urologic Pathology classification of urothelial neoplasms: Practical choices for patient care
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DOI：
10.1016/s0022-5347(05)64553-3
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发表时间：
2002-09-01
影响因子：
6.6
通讯作者：
Maruniak, NA
中科院分区：
文献类型：
--
作者：
Murphy, WM;Takezawa, K;Maruniak, NA
目的：由专家设计的根据生物学潜能对肿瘤进行分层的形态学分类必须定义在从业者中可重复的类别，否则该方案实际上会产生他们试图避免的异质性人群。1998年世界卫生组织/国际泌尿系病理学协会计划尿路上皮肿瘤的应用进行了研究，在社区实践设置。我们记录了每类肿瘤的解释差异，并确定一段时间的病理学家教育是否可能对不一致解释的频率产生积极影响。结果表明，患者可能会受益于修改的分类system.Materials和方法：一个连续的一系列标本分为学习和研究集，每个独立的3病理学家进行检查。在学习组中的标本在没有先前的结构化教育的情况下进行解释，而在研究组中的标本在强化教育后立即进行解释。每个标本的解释进行了比较和解释的差异进行了analysed.Results：教育后的病例分布是相似的病理学家，但任何特定的标本解释往往不同。解释差异的水平根据分类方案中类别之间的形态相似性而变化，并且不一定会因教育而减少。当病理学家被要求区分低恶性潜能的乳头状尿路上皮肿瘤和低级别癌时，教育后的差异为50%，而教育前为39%。相反，当区分低度恶性潜能的乳头状尿路上皮肿瘤和高度恶性肿瘤或原位癌时，没有差异。消除类别的可重复性差显着提高了一致同意的可能性从业者之间，但可能无法降低的水平10%的差异remained.Conclusions：1998年世界卫生组织/国际泌尿外科病理学学会分类尿路上皮肿瘤需要一定的歧视，不能可靠地由从业者。修改该方案以创建低级别肿瘤和高级别癌的类别将显著增加其对患者的实用价值，而不会显著改变患者护理。
Purpose: Morphological classifications designed by experts to stratify neoplasms according to biological potential must define categories that are reproducible among practitioners or the schemes actually create the heterogeneous populations that they seek to avoid. The application of the 1998 World Health Organization/International Society of Urologic Pathology scheme for urothelial neoplasms was studied in a community practice setting. We documented interpretive discrepancies for each category of neoplasm and determined whether a period of pathologist education may have a positive effect on the frequency of discrepant interpretations. The results suggest that patients may benefit from modifying the classification system.Materials and Methods: A consecutive series of specimens was divided into learning and study sets that were each independently examined by 3 pathologists. Specimens in the learning set were interpreted without previous structured education, while those in the study set were interpreted immediately after intensive education. Interpretations for each specimen were compared and interpretive discrepancies were analyzed.Results: Case distribution after education was similar among the pathologists but interpretations for any particular specimen often differed. The level of interpretive discrepancies varied according to the morphological similarity among categories in the classification scheme and was not necessarily decreased by education. When pathologists were required to discriminate between papillary urothelial neoplasm of low malignant potential and low grade carcinoma, the discrepancies were 50% after education compared with 39% before education. In contrast, there were no discrepancies when the discrimination was between papillary urothelial neoplasm of low malignant potential and high grade carcinoma or carcinoma in situ. Eliminating categories with poor reproducibility markedly improved the likelihood of unanimous agreement among practitioners but a probably irreducible level of 10% discrepancies remained.Conclusions: The 1998 World Health Organization/International Society of Urologic Pathology classification of urothelial neoplasms requires certain discriminations that cannot be reliably made by practitioners. Modifying the scheme to create categories of low grade neoplasm and high grade carcinoma would markedly increase its practical value to patients without significantly altering patient care.