Interobserver reliability in the histopathologic diagnosis of oral pre-malignant and malignant lesions
Interobserver reliability in the histopathologic diagnosis of oral pre-malignant and malignant lesions
复制标题
DOI：
10.1111/j.1600-0714.2004.0037n.x
复制
发表时间：
2004-02-01
影响因子：
3.3
通讯作者：
Schwartz, SM
中科院分区：
文献类型：
--
作者：
Fischer, DJ;Epstein, JB;Schwartz, SM
背景技术背景：癌前病变和癌性口腔病变的组织学分类一般表现出较差的协议病理学家之间，但病变和患者的特点，可能会影响诊断的可靠性尚未explored.METHODS：87个临床可疑的口腔病变活检81例上呼吸消化道癌分别由当地的病理学家和中央病理委员会独立分类。采用加权kappa（kappa（w））统计量和相应的95%可信区间（CI）衡量当地病理学家和中心病理委员会之间的观察者间信度。（95% CI：0.45，0.72），无炎症病变（0.67（95% CI：0.53，0.80））高于炎症病变（-0.10（95% CI：-0.27，0.07））。颊粘膜/前庭（kappa（w）= 0.68（95% CI：0.46，0.91））和舌（kappa（w）= 0.62（95% CI：0.40，0.84））病变的一致性最高。唇/唇粘膜病变的一致性最低（kappa（w）= -0.04（95% CI：-0.34，0.27））。打孔活检（kappa（w）= 0.67（95%CI：0.54，0.80））比楔形活检（kappa（w）= 0.38（95%CI：0.12，0.64））具有更高的观察者间可靠性。结论：这些数据表明，炎症、病变部位和活检技术的存在改变了口腔病变组织学诊断的可靠性。
BACKGROUND: The histologic classification of pre-cancerous and cancerous oral lesions has generally shown poor agreement between pathologists, but lesion and patient characteristics that may affect diagnostic reliability have not been explored.METHODS: Eighty-seven clinically suspicious oral lesions biopsied from 81 patients with previous upper aerodigestive tract cancer were independently classified by their local pathologist and a central pathology committee. Interobserver reliability between the local pathologist and the central pathology committee was measured with weighted kappa (kappa(w)) statistics and corresponding 95% confidence intervals (CI).RESULT: The kappa(w) for pathologic diagnosis was 0.59 (95% CI: 0.45, 0.72), and was higher for lesions without inflammation (0.67 (95% CI: 0.53, 0.80) than inflamed lesions (-0.10 (95% CI: -0.27, 0.07)). Greatest agreement was seen for lesions located in the buccal mucosa/vestibule (kappa(w) = 0.68 (95% CI: 0.46, 0.91)) and tongue (kappa(w) = 0.62 (95% CI: 0.40, 0.84)). Least agreement was found for lip/labial mucosa lesions (kappa(w) = -0.04 (95% CI: -0.34, 0.27)). Punch biopsies (kappa(w) = 0.67 (95% CI: 0.54, 0.80)) had greater interobserver reliability than wedge biopsies (kappa(w) = 0.38 (95% CI: 0.12, 0.64)).CONCLUSIONS: These data suggest that the presence of inflammation, lesion site, and biopsy technique modifies the reliability of oral lesion histologic diagnoses.