HISTOLOGICAL GRADING OF BREAST CARCINOMAS - A STUDY OF INTEROBSERVER AGREEMENT
HISTOLOGICAL GRADING OF BREAST CARCINOMAS - A STUDY OF INTEROBSERVER AGREEMENT
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DOI：
10.1016/0046-8177(95)90010-1
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发表时间：
1995-08-01
期刊：
影响因子：
3.3
通讯作者：
ELSTON, C
中科院分区：
文献类型：
--
作者：
ROBBINS, P;PINDER, S;ELSTON, C
观察者之间的差异，在乳腺癌的组织学分级进行了研究，使用的假设，最佳的固定，更精确的分级指南，一些经验，使用训练和测试集，并与专家组的结果比较可能会允许更高水平的协议。对于训练集，来自50个连续的乳腺癌病例的切片，这些乳腺癌病例在查尔斯爵士医院（SCGH）接收并固定在B5和缓冲的正规盐水（BFS）中，由SCGH的三位病理学家一致同意，并由诺丁汉城市医院（NCH）的两位病理学家独立地一致同意，使用改良的Scarff-Bloom-Richardson组织学分级系统与NCH病理学家建议的指南。NCH病理学家判断切片质量和核形态保存程度上级B5固定材料。83.3%的B5固定病例和73.5%的BFS固定病例（P = 0.05）的SCGH和NCH结果之间的等级完全一致，相对不一致率（RDRs）分别为0.15和0.29，kappa统计值分别为0.73和0.58。肾小管形成、核评分和有丝分裂计数达到约80%的完全一致性，RDR范围为0.19至0.27，kappa值为0.46至0.69。在B5和BFS固定材料中，SCGH结果一致偏向于较高的小管评分，因为筛状或复杂腺体模式的解释存在差异，并且SCGH结果一致偏向于B5和BFS材料较低的核大小/多形性评分。对于测试集，使用类似的标准，但考虑到训练集显示的误差来源，检查了来自B5中固定的另外50个连续乳腺癌病例的切片。等级组分和等级再次达到约80%的完全一致性（RDR，0.18和0.72）。系统偏倚在测试集中减少，但未观察到其他改善。在NCH指定为I级的肿瘤中，87.5%在B5训练集中被SCGH称为I级肿瘤，84.6%在B5测试集中，66.6%在BFS训练集中。在训练集和测试集中显示的一致性水平是令人满意的，比我们以前的研究有了显着的改善，这表明经验和精确的分级指南是有价值的。训练集和测试集的相似一致性水平表明，不需要专家组的直接训练就可以取得合理的结果。最佳固定的价值可能是该研究指出的最重要的变量。版权所有（C）1995由W.B.桑德斯公司
Interobserver variation in the histological grading of breast carcinoma was investigated using the hypothesis that optimal fixation, more precise grading guidelines, some experience, the use of training and test sets, and a comparison of results with an expert group might allow higher levels of agreement. For the training sets sections from 50 consecutive cases of breast carcinoma received at the Sir Charles Gairdner Hospital (SCGH) and fixed in both B5 and buffered formal saline (BFS) were graded by consensus of three pathologists at the SCGH and independently by consensus of two pathologists at the Nottingham City Hospital (NCH) using a modified Scarff-Bloom-Richardson histological grading system with guidelines as suggested by NCH pathologists. The section quality and degree of preservation of nuclear morphology were judged by NCH pathologists to be superior for B5-fixed material. Complete agreement in grade between SCGH and NCH results was achieved for 83.3% of B5-fixed cases and 73.5% of BFS-fixed cases (P =.05) with relative disagreement rates (RDRs) of 0.15 and 0.29 and kappa statistic values of 0.73 and 0.58, respectively. Approximately 80% complete agreement was achieved for tubule formation, nuclear score, and mitotic count, with RDRs ranging from 0.19 to 0.27 and kappa values from 0.46 to 0.69. There was a consistent bias in the SCGH results toward a higher tubule score in both B5 and BFS-fixed material because of a difference in interpretation of cribriform or complex gland patterns and a consistent bias in SCGH results toward a lower nuclear size/pleomorphism score for B5 and BFS material. For the test set sections from 50 further consecutive cases of breast cancer fixed in B5 were examined using similar criteria but taking into account the sources of error shown by the training set. Approximately 80% complete agreement was again achieved for grade components and grade (RDRs, 0.18 and 0.72). Systematic bias was reduced in the test set, but no other improvement was observed. Of the tumors designated as grade I by NCH, 87.5% were called grade I tumors by SCGH in the B5 training set, 84.6% in the B5 test set, and 66.6% in the BFS training set. The levels of agreement shown in both the training and test sets were satisfactory and represented a significant improvement over our previous study, suggesting that experience and precise grading guidelines are of value. The similar levels of agreement in training and test sets suggest that reasonable results can be achieved without direct training by expert groups. The value of optimal fixation may be the most important variable noted by the study. Copyright (C) 1995 by W.B. Saunders Company.