Interobserver and intraobserver variability of a two-tier system for grading ovarian serous carcinoma
Interobserver and intraobserver variability of a two-tier system for grading ovarian serous carcinoma
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DOI：
10.1097/pas.0b013e31803199b0
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发表时间：
2007-08-01
影响因子：
5.6
通讯作者：
Silva, Elvio G.
中科院分区：
文献类型：
--
作者：
Malpica, Anais;Deavers, Michael T.;Silva, Elvio G.
虽然分级已被证明是卵巢浆液性癌的一个重要预后因素，但目前还没有普遍使用的系统来执行这项任务。几年前，我们提出了卵巢浆液性癌分级的两层系统，该系统主要基于肿瘤最严重区域核异型性（均匀性与多形性）的评估。在这个双层系统中，肿瘤分级与生存相关。在德克萨斯大学安德森癌症中心（MDACC）的众多病理学家和实习生使用了15年后，我们观察到该系统是用户友好的和可复制的。我们进行了这项研究，以评估7名妇科病理学家和2名普通外科病理学家使用该评分系统的观察者之间和观察者内部的变异性。共80例卵巢浆液性癌，低分级40例，高分级40例。低级别和高级别浆液性癌的载玻片都是未知的。一个网站用于提供诊断标准，卵巢低级别和高级别癌的图像，以及一个日志表格，以方便数据输入。统计分析表明，不同观察者之间的总体kappa统计量为0.909。第一轮评审的综合评分kappa值为0.717 ~ 1.000，第二轮评审的综合评分kappa值为0.701 ~ 1.000。8个参与者的内部kappa范围从0.775到1.000（非常一致），而单个参与者的内部kappa为0.725（良好一致）。本研究表明，基于核异型性评估的两级分级系统（MDACC分级系统）对卵巢浆液性癌具有易学性和高度可重复性。这些发现将支持其普遍使用，这将有利于临床试验和方案的标准化，从而促进对这种疾病的了解和对受这些肿瘤影响的患者治疗的调查。
Although grading has been demonstrated to be an important prognostic factor in ovarian serous carcinoma, there is no system universally used to perform this task. A few years ago, we proposed a two-tier system for grading ovarian serous carcinoma that is based primarily on the assessment of nuclear atypia (uniformity vs. pleomorphism) in the worst area of the tumor. Tumor grade in this two-tier system is correlated with survival. After being used by numerous pathologists and trainees at The University of Texas M.D. Anderson Cancer Center (MDACC) for 15 years, we have observed that this system is user-friendly and reproducible. We undertook this study to evaluate the interobserver and intraobserver variability among a group of 7 gynecologic pathologists and 2 general surgical pathologists using this grading system. A total of 80 cases of ovarian serous carcinoma, 40 low-grade and 40 highgrade, were circulated twice among these pathologists. Slides with examples of low-grade and high-grade serous carcinoma were sent with the unknowns. A website was used to provide diagnostic criteria, images of examples of ovarian low-grade and high-grade carcinoma, and a log form to facilitate data entry. Statistical analysis demonstrated an overall kappa statistic among the different observers of 0.909. The intergrader kappa's ranged from 0.717 to 1.000 in the first round of the review and from 0.701 to 1.000 in the second round. Eight of the participants had an intragrader kappa ranging from 0.775 to 1.000 (excellent agreement), whereas a single participant had an intragrader kappa of 0.725 (good agreement). This study demonstrates that the two-tier grading system (the MDACC grading system) for ovarian serous carcinoma on the basis of the assessment of nuclear atypia kappa easy to learn and is highly reproducible. These findings would support its universal use, which would be beneficial for the standardization of clinical trials and protocols, thus facilitating the understanding of this disease and investigation into the treatment of patients affected by these tumors.