Colquhoun Patrick, Nogueras Juan J, Dipasquale Bruno, Petras Robert, Wexner Steven D, Woodhouse Sherry
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, 33331, USA.
Dis Colon Rectum. 2003 Oct;46(10):1332-6; discussion 1336-8. doi: 10.1007/s10350-004-6744-5.
Natural history of progression from anal intraepithelial neoplasia to invasive carcinoma remains unproven. The risk of progression may be linked to the severity of dysplasia. Important therapeutic decisions are thus based on the severity of anal intraepithelial neoplasia. Consistency and reliability in the interpretation of anal intraepithelial neoplasia are unproven.
One hundred ninety anal biopsy specimens were identified for review of dysplasia with a six-point grade system from normal to invasive cancer, evidence of human papillomavirus infection, and quality of histology by three pathologists.
Results revealed poor to moderate agreement on grading of quality of histology (weighted kappa score, 0.07-0.22), human papillomavirus status (weighted kappa score, 0.24-0.53), and dysplasia (weighted kappa score, 0.38-0.7). Complete agreement between the original pathology and the three pathologists was observed in only 32 percent of cases. Analysis of 86 slides previously read by one of the pathologists revealed only moderate agreement, with a weighted kappa score of 0.64.
Significant interobserver and intraobserver bias exists in the interpretation of anal intraepithelial neoplasia. These inconsistencies may explain the uncertainty about the natural progression of anal intraepithelial neoplasia and the varied results of surgery reported for anal intraepithelial neoplasia in the literature.
肛管上皮内瘤变进展为浸润性癌的自然病程仍未得到证实。进展风险可能与发育异常的严重程度有关。因此，重要的治疗决策基于肛管上皮内瘤变的严重程度。肛管上皮内瘤变解读的一致性和可靠性尚未得到证实。
识别出190份肛管活检标本，由三名病理学家采用从正常到浸润性癌的六点分级系统对发育异常、人乳头瘤病毒感染证据以及组织学质量进行评估。
结果显示，在组织学质量分级（加权kappa评分，0.07 - 0.22）、人乳头瘤病毒状态（加权kappa评分，0.24 - 0.53）和发育异常分级（加权kappa评分，0.38 - 0.7）方面，一致性较差至中等。仅32%的病例中观察到原始病理与三名病理学家之间完全一致。对一名病理学家之前读过的86张玻片进行分析，结果显示一致性仅为中等，加权kappa评分为0.64。
在肛管上皮内瘤变的解读中存在显著的观察者间和观察者内偏差。这些不一致性可能解释了肛管上皮内瘤变自然进展的不确定性以及文献中报道的肛管上皮内瘤变手术结果的差异。
