Breast Cancer Prognostic Factors in the Digital Era: Comparison of Nottingham Grade using Whole Slide Images and Glass Slides.
Breast Cancer Prognostic Factors in the Digital Era: Comparison of Nottingham Grade using Whole Slide Images and Glass Slides.
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DOI：
10.4103/jpi.jpi_29_18
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Elmore, Joann G
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文献类型：
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作者：
Davidson, Tara M;Rendi, Mara H;Elmore, Joann G
背景技术背景：为了评估再现性和准确性的整体诺丁汉等级和组件的分数使用数字全载玻片图像（WSI）相比，玻璃slide.METHODS：二百零八病理学家被随机独立解释1的4个乳腺活检集使用玻璃载玻片或数字WSI。每组包括5或6例浸润性癌（共22例浸润性病例）。参与者在第二次随机分配到WSI或载玻片后约9个月后解释相同的活检集。诺丁汉等级，包括组件的分数，进行了评估的每一个解释，提供2045个独立的解释等级。比较病理学家之间的总体分级和组分评分（观察者间一致性）和同一病理学家的解释（观察者内一致性）。等级评估进行比较时，格式结果：两种解释中使用玻片的观察者内诺丁汉分级一致性最高（73%，95%置信区间[CI]：68%，78%），使用数字WSI进行两种解读时略低，但无统计学差异（68%，95% CI：61%，75%; P= 0.22）。当解释之间的格式发生变化时，一致性最低（63%，95% CI：59%，68%）。与数字WSI相比，使用载玻片的观察者间一致性显著更高（P < 0.001）（分别为68%，95% CI：66%，70% vs 60%，95% CI：57%，62%）。核多形性评分在观察者间和观察者内的一致性最低。在观察者间和观察者内比较中，载玻片上的有丝分裂评分较高。结论：病理学家使用载玻片或WSI的观察者内一致性（重现性）与诺丁汉级别相似。然而，病理学家之间的一致性略低，表明使用数字WSI验证等级可能更具挑战性。
BACKGROUND: To assess reproducibility and accuracy of overall Nottingham grade and component scores using digital whole slide images (WSIs) compared to glass slides.METHODS: Two hundred and eight pathologists were randomized to independently interpret 1 of 4 breast biopsy sets using either glass slides or digital WSI. Each set included 5 or 6 invasive carcinomas (22 total invasive cases). Participants interpreted the same biopsy set approximately 9 months later following a second randomization to WSI or glass slides. Nottingham grade, including component scores, was assessed on each interpretation, providing 2045 independent interpretations of grade. Overall grade and component scores were compared between pathologists (interobserver agreement) and for interpretations by the same pathologist (intraobserver agreement). Grade assessments were compared when the format (WSI vs. glass slides) changed or was the same for the two interpretations.RESULTS: Nottingham grade intraobserver agreement was highest using glass slides for both interpretations (73%, 95% confidence interval [CI]: 68%, 78%) and slightly lower but not statistically different using digital WSI for both interpretations (68%, 95% CI: 61%, 75%; P= 0.22). The agreement was lowest when the format changed between interpretations (63%, 95% CI: 59%, 68%). Interobserver agreement was significantly higher (P < 0.001) using glass slides versus digital WSI (68%, 95% CI: 66%, 70% versus 60%, 95% CI: 57%, 62%, respectively). Nuclear pleomorphism scores had the lowest inter- and intra-observer agreement. Mitotic scores were higher on glass slides in inter- and intra-observer comparisons.CONCLUSIONS: Pathologists' intraobserver agreement (reproducibility) is similar for Nottingham grade using glass slides or WSI. However, slightly lower agreement between pathologists suggests that verification of grade using digital WSI may be more challenging.