Franc B, Valenty M, Galakhin K, Kovalchuk E, Kulagenko V, Puchkou A, Sidorov Y, Tirmarche M
Service Anatomie et Cytologie Pathologiques, Hôpital Ambroise Paré, 92100 Boulogne, France.
Br J Cancer. 2003 Dec 1;89(11):2098-103. doi: 10.1038/sj.bjc.6601395.
In order to evaluate the diagnostic reliability of the thyroid cancers listed in adult registries from the Ukraine and Belarus, a histological review was organised of 327 randomly selected thyroid carcinoma cases diagnosed between 1980 and 1999. A final diagnosis was reached at a 5-day consensus conference by six pathologists who met around a multiheaded microscope. The study concluded with a comparison between the final diagnosis and the initial diagnosis. The pathologists agreed with the initial diagnosis of malignancy in 286 cases (88%). A final diagnosis of papillary, follicular or medullary thyroid carcinoma was reached in 86, 4, and 6% of the cases respectively. In 2.8% of the cases reviewed, diagnostic discrepancies persisted. The percentage of agreement between the final diagnosis and the initial diagnosis was 93%, with a weighted kappa-statistic of 0.61 (confidence interval 95% (CI(95%)): [0.45-0.77]). In all, 89% of the 286 confirmed cancer cases were in agreement for the type of cancer, with a kappa-statistic of 0.56 (CI(95%): [0.43-0.69]). The level of agreement differed according to cancer categories, with concordance rates of 94, 40 and 33% for papillary, follicular and medullary thyroid carcinomas respectively. The low prevalence of follicular thyroid carcinomas in the adult population studied calls for further exploration. The discrepancies and classification difficulties encountered were analysed.
为评估乌克兰和白俄罗斯成人登记处列出的甲状腺癌的诊断可靠性，对1980年至1999年间随机选取的327例甲状腺癌病例进行了组织学复查。由六名病理学家围坐在多头显微镜旁，在为期5天的共识会议上得出最终诊断。该研究最后对最终诊断和初始诊断进行了比较。病理学家在286例病例（88%）中认可了初始的恶性诊断。分别有86%、4%和6%的病例最终诊断为乳头状、滤泡状或髓样甲状腺癌。在复查的病例中，2.8%存在诊断差异。最终诊断与初始诊断的一致率为93%，加权kappa统计量为0.61（95%置信区间（CI(95%)）：[0.45 - 0.77]）。在286例确诊的癌症病例中，总体上89%的病例在癌症类型上达成一致，kappa统计量为0.56（CI(95%)：[0.43 - 0.69]）。一致程度因癌症类别而异，乳头状、滤泡状和髓样甲状腺癌的一致率分别为94%、40%和33%。所研究的成年人群中滤泡状甲状腺癌患病率较低，需要进一步探索。分析了遇到的差异和分类困难。
