Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials.
Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials.
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DOI：
10.1016/j.oooo.2015.05.023
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发表时间：
2015-10
期刊：
影响因子：
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通讯作者：
McDevitt JT
中科院分区：
文献类型：
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作者：
Speight PM;Abram TJ;Floriano PN;James R;Vick J;Thornhill MH;Murdoch C;Freeman C;Hegarty AM;D'Apice K;Kerr AR;Phelan J;Corby P;Khouly I;Vigneswaran N;Bouquot J;Demian NM;Weinstock YE;Redding SW;Rowan S;Yeh CK;McGuff HS;Miller FR;McDevitt JT
观察者之间在口腔上皮异型增生(OED)分级方面的一致意见是出了名的不可靠，并可能为开发新的分子标记和诊断技术设置障碍。本文旨在报告3个阶段的组织病理学审查和裁决过程的细节，目的是实现对每个活检的组织病理学诊断的共识。来自846名患者的口腔病变的两个相邻的连续组织切片由两个不同的病理学家从四个池中独立评分。在最初的两位病理学家意见不一致的情况下，第三位独立判定的病理学家对两个部分进行了审查。如果未能达成多数协议，第三阶段将进行面对面的协商一致审查。个体病理学家对Kappa值介于0.251-0.706之间(一般-良好)。在最初的复习阶段，两位病理学家对69.9%的病例的诊断达成了一致。在第三位病理学家的裁决复审后，另外22.8%的病例得到了一致的诊断(3位病理学家中有2位一致)。经过面对面的审查，其余7.3%的病例得到了一致的诊断。明确的方案的使用导致诊断一致性的大幅增加(30%)，并有可能提高建立基于组织病理学诊断的研究的金标准的一致性水平。
Inter-observer agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. Two adjacent serial histological sections of oral lesions from 846 patients were independently scored by two different pathologists from a pool of four. In instances where the original two pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. Individual pathologist pair kappa values ranged from 0.251 – 0.706 (fair – good) before the 3-stage review process During the initial review phase, the two pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). Following the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis.