Reproducibility of pathologic scoring systems for periprosthetic adverse local tissue reactions: A cross-sectional study.
Reproducibility of pathologic scoring systems for periprosthetic adverse local tissue reactions: A cross-sectional study.
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DOI：
10.1016/j.prp.2021.153685
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Koff MF
中科院分区：
文献类型：
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作者：
Bauer TW;Zhang Y;Gao MA;Lin BQ;Koff MF
之前的几项研究描述了假体周围反应的广泛组织学分类，可能反映了关节置换术失败的潜在机制;然而，尚未就个体观察结果的相对重要性达成共识。本研究的目的是评价常用组织病理学分级方法的检查者间重复性，并确定在接受各种关节面组合植入物的翻修THA手术的患者中分配更简单的整体分类的效用。2013年3月至2020年2月期间，共有2，131例患者在一家临床试验机构接受了髋关节置换翻修术，其中12%（248/2，131）的患者入组。两位病理学家独立审查了这些患者假体周围组织的显微镜载玻片，其中425张载玻片（229例髋关节，222例受试者）由两位病理学家审查。单独的载玻片用于病理学家的先验培训。采用坎贝尔无菌性淋巴细胞主导型血管炎相关病变（ALVAL）评分、经Grammatopolous改良的Oxford ALVAL评分、Fujishiro和Natu评分以及与Krenn等人相似的拟定简化模式分类（纳入了这些现有评分方法的个体因素，并且先前显示与磁共振成像结果相对应）评价载玻片。评价者之间的协议进行了评估，使用Gwet的AC 1和AC 2系数和对应分析被用来检查先前的评分方法与建议的主要模式的个人因素之间的关联。在71%（15/21）的个体因素中发现了几乎完美的评定者间重复性（Gwet’s AC 2> 0.8），并且在提议的主要总体模式中发现了实质性的评定者间一致性（Gwet’s AC 1：0.80，95%CI：0.72至0.85）。对应分析能够解释89%至91%的数据变异性，并且能够识别通常与主要模式不相关的个体特征，但可区分主要模式，例如ALVAL的“淋巴袖厚度0.25-0.5”。与以前的考试相比，优秀的评分员之间的协议被发现，这可能是由于先验训练的评分员与测试集的幻灯片或难以解释的评分标准。提出的简化的主要模式分类可能有助于评价组织病理学组织样本。
Several previous studies have described broad histologic classifications of peri-prosthetic reactions that likely reflect the underlying mechanism of arthroplasty failure; however, a consensus has not yet been reached about the relative importance of individual observations. The purpose of this study was to evaluate the inter-examiner repeatability of commonly used histopathologic grading methods, and to determine the utility of assigning a more simple, global categorization in patients undergoing revision THA surgery of implants with a variety of bearing combinations. Between March 2013 and February 2020, a total of 2,131 patients underwent revision hip arthroplasty surgery at a one center, of which 12% (248 of 2,131) of patients were enrolled. Two pathologists independently reviewed microscope slides of periprosthetic tissue from these patients, of which 425 slides (229 hips, 222 subjects) were reviewed by both pathologists. Separate slides were used for a priori training of the pathologists. Slides were evaluated with the Campbell Aseptic Lymphocyte-dominant Vasculitis-Associated Lesion (ALVAL) score, the Oxford ALVAL score as modified by Grammatopolous, the Fujishiro and Natu scores, and a proposed simplified pattern classification, similar to that of Krenn et al, that incorporates individual factors of these existing scoring methods and was previously shown to correspond to Magnetic Resonance Imaging findings. Inter-rater agreement was assessed using Gwet’s AC1 and AC2 coefficients and correspondence analysis was used to examine associations between individual factors of prior scoring methods with the proposed major pattern. Almost perfect inter-rater repeatability (Gwet’s AC2 > 0.8) was found for 71% (15/21) of the individual factors, and substantial interrater agreement was found for the proposed major overall pattern (Gwet’s AC1: 0.80, 95%CI: 0.72 to 0.85). Correspondence analysis was able to explain 89% to 91% of data variability and was able to identify individual features not commonly associated with a major pattern, but discriminatory of the major pattern, such as “Lymph Cuff Thickness 0.25–0.5” with ALVAL. In contrast to prior examinations, excellent interrater agreement was found that may be attributable to a priori training of raters with a test set of slides or difficulty of interpreting grading criteria. The proposed simplified major pattern classification may facilitate evaluation of histopathologic tissue samples.