Frequency and determinants of disagreement and error in gleason scores: A population-based study of prostate cancer
Frequency and determinants of disagreement and error in gleason scores: A population-based study of prostate cancer
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DOI：
10.1002/pros.22484
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发表时间：
2012-09-01
期刊：
影响因子：
2.8
通讯作者：
Amin, Mahul B.
中科院分区：
文献类型：
--
作者：
Goodman, Michael;Ward, Kevin C.;Amin, Mahul B.
背景：为了研究影响前列腺癌分级准确性和可靠性的因素，我们比较了病理报告中记录的Gleason评分和泌尿科病理学家在一项基于人群的研究中给出的评分。方法对318例前列腺癌患者进行分层随机抽样，以确保白人和非裔美国人的代表性，并包括各种类型的设施。从报告机构借来的幻灯片被扫描，结果的数字图像由两名泌尿科病理学家重新审查。如果两位泌尿系统病理学家意见不一致，则请第三位泌尿系统病理学家帮助得出最终的金标准结果。通过计算kappa统计量来检验审稿人之间以及病理报告与金标准之间的一致性。使用多变量模型评估Gleason评分不一致的决定因素，结果以比值比（OR）和95%置信区间（CI）表示。结果：反映病理报告与金标准一致的kappa值（95% CI），活检的kappa值为0.61 (95% CI: 0.54, 0.68)，前列腺切除术的kappa值为0.37（0.23,0.51）。63%不一致的活组织检查和72%不一致的前列腺切除术显示只有微小的差异。使用独立实验室作为参考，病理报告和专家指定的活检Gleason评分之间不一致的可能性在小型社区医院特别高（OR = 2.98; 95% CI: 1.73, 5.14）。结论：病理报告与专家评审的一致程度取决于诊断设备的类型，但也可能取决于个别病理学家的专业水平和专业化程度。《中华医学会杂志》，2012。(c) 2012 Wiley期刊有限公司
BACKGROUND To examine factors that affect accuracy and reliability of prostate cancer grade we compared Gleason scores documented in pathology reports and those assigned by urologic pathologists in a population-based study. METHODS A stratified random sample of 318 prostate cancer cases was selected to ensure representation of whites and African-Americans and to include facilities of various types. The slides borrowed from reporting facilities were scanned and the resulting digital images were re-reviewed by two urologic pathologists. If the two urologic pathologists disagreed, a third urologic pathologist was asked to help arrive at a final gold standard result. The agreements between reviewers and between the pathology reports and the gold standard were examined by calculating kappa statistics. The determinants of discordance in Gleason scores were evaluated using multivariate models with results expressed as odds ratios (OR) and 95% confidence intervals (CI). RESULTS The kappa values (95% CI) reflecting agreement between the pathology reports and the gold standard, were 0.61 (95% CI: 0.54, 0.68) for biopsies, and 0.37 (0.23, 0.51) for prostatectomies. Sixty three percent of discordant biopsies and 72% of discordant prostatectomies showed only minimal differences. Using freestanding laboratories as reference, the likelihood of discordance between pathology reports and expert-assigned biopsy Gleason scores was particularly elevated for small community hospitals (OR?=?2.98; 95% CI: 1.73, 5.14). CONCLUSIONS The level of agreement between pathology reports and expert review depends on the type of diagnosing facility, but may also depend on the level of expertise and specialization of individual pathologists. Prostate 72:13891398, 2012. (c) 2012 Wiley Periodicals, Inc.