Novel prognostic histopathological grading system in oral squamous cell carcinoma based on tumour budding and cell nest size shows high interobserver and intraobserver concordance
Novel prognostic histopathological grading system in oral squamous cell carcinoma based on tumour budding and cell nest size shows high interobserver and intraobserver concordance
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DOI：
10.1136/jclinpath-2018-205454
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发表时间：
2019-04-01
影响因子：
3.4
通讯作者：
Weichert, Wilko
中科院分区：
文献类型：
--
作者：
Boxberg, Melanie;Bollwein, Christine;Weichert, Wilko
口腔鳞状细胞癌（OSCC）是一种常见的肿瘤实体，具有可变的，部分高度侵袭性的临床过程。最近，我们提出了一种新的（三层）临床上有用的分级方案，与患者的结果在口腔鳞癌，包括组织形态学模式的肿瘤出芽和细胞巢大小的总和得分优于目前使用的基于WHO的分级算法。本研究的目的是探讨这种新的分级系统的观察者间和观察者内的可靠性。方法由三名独立的病理学家--两名经验丰富的头颈部病理学家和一名正在接受培训的病理学家--根据提出的分级方案对108例口腔鳞癌进行回顾性评分。结果经验丰富的病理学家之间的一致率的Cohen's Kappa（kappa）值为：总体评分为0.97，出芽活动的kappa=0.97，细胞巢大小的kappa=0.91，表明我们提出的评分系统具有很强的观察者间可靠性。在培训中，与病理学家的初始观察者间一致性明显较低（总体评分kappa=0.55），但在培训后显著改善（总体评分kappa=0.87）。观察者内一致性高（kappa=0.95的整体等级），表明高再现性的algorithm.Conclusions，我们的研究表明，口腔鳞癌分级的基础上，我们提出的新方案产生了良好的读者间和读者内协议，进一步支持这种分级系统的适用性，为常规病理实践。
Aims Squamous cell carcinoma of the oral cavity (OSCC) is a common tumour entity with a variable, partially highly aggressive clinical course. Recently, we proposed a novel (three-tiered) clinically useful grading scheme strongly associated with patient outcome in OSCC, consisting of a sum score of the histomorphological patterns tumour budding and cell nest size which outperforms WHO based grading algorithms currently in use. The aim of our study was to probe for interobserver and intraobserver reliability of this novel grading system.Methods 108 OSCC were retrospectively scored according to the proposed grading scheme by three independent pathologists-two experienced head and neck pathologists and one pathologist in training-blinded to each other's scoring results.Results The Cohen's Kappa (kappa) values for concordance rates between experienced pathologists were kappa=0.97 for the overall grade, kappa=0.97 for budding activity and kappa=0.91 for cell nest size, indicating a strong interobserver reliability of our proposed grading system. Initial interobserver agreement was markedly lower with the pathologist in training (kappa=0.55 for overall grade) but improved significantly after a training session (kappa=0.87 for overall grade). Intraobserver concordance was high (kappa=0.95 for overall grade), indicating a high reproducibility of the algorithm.Conclusions In conclusion, our study indicates that OSCC grading based on our proposed novel scheme yields an excellent inter-reader and intrareader agreement, further supporting the suitability of this grading system for routine pathological practice.