肛管上皮内瘤变解读中的观察者间一致性

Interobserver agreement in the interpretation of anal intraepithelial neoplasia.

作者信息

Lytwyn Alice, Salit Irving E, Raboud Janet, Chapman William, Darragh Teresa, Winkler Barbara, Tinmouth Jill, Mahony James B, Sano Marie

机构信息

Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.

出版信息

Cancer. 2005 Apr 1;103(7):1447-56. doi: 10.1002/cncr.20927.

DOI:10.1002/cncr.20927

PMID:15726546

Abstract

BACKGROUND

Anal carcinoma incidence is increasing, and is highest among men with human immunodeficiency virus (HIV) infection who have sex with men. Anal carcinoma and anal intraepithelial neoplasia (AIN) are ascertained on tissue histology, but requires invasive procedures. Screening for AIN using anal cytology was suggested. The authors evaluated agreement on cytologic and biopsy specimens from HIV-positive men undergoing anal carcinoma screening.

METHODS

One hundred twenty-nine HIV-positive men with a history of anal-receptive intercourse underwent anal cytology, anoscopy, and biopsy. Four pathologists independently assessed cytology and biopsy specimens and reached consensus for discordant cases.

RESULTS

Each pathologist evaluated 120 cytology and 155 biopsy specimens. The weighted kappa value for overall agreement was 0.54 (95% confidence interval [CI], 0.49-0.59) for cytology specimens and 0.59 (95%CI, 0.55-0.63) for biopsy specimens. The median kappa values for pairwise agreement among pathologists and for agreement with consensus were, respectively, 0.69 and 0.77 for cytology and 0.66 and 0.75 for biopsy. At least 3 pathologists were in agreement for 92 (76.7%) cytology and 134 (86.5%) biopsy specimens. Reliability for the Bethesda classification system was at least moderate, except for the cytologic category of atypical squamous cells of undetermined significance (kappa = 0.12). Fourteen of 29 (48.3%) cytology specimens and 36 of 47 (76.6%) biopsy specimens with consensus interpretation of high-grade squamous intraepithelial lesions (HSIL) were interpreted originally as HSIL by > or = 3 pathologists. The kappa value for agreement with consensus distinguishing HSIL from non-HSIL ranged from 0.55 to 0.88 for cytology specimens and from 0.76 to 0.94 for biopsy specimens.

CONCLUSIONS

Agreement for cytologic and biopsy interpretations was generally at least moderate. Nevertheless, these results supported the need for disease indicators with greater reliability.

摘要

背景

肛管癌的发病率正在上升，在感染人类免疫缺陷病毒（HIV）且有男男性行为的男性中发病率最高。肛管癌和肛管上皮内瘤变（AIN）通过组织病理学确定，但需要侵入性操作。有人建议使用肛门细胞学检查来筛查AIN。作者评估了接受肛管癌筛查的HIV阳性男性的细胞学和活检标本的一致性。

方法

129名有肛门性交史的HIV阳性男性接受了肛门细胞学检查、肛门镜检查和活检。四名病理学家独立评估细胞学和活检标本，并就不一致的病例达成共识。

结果

每位病理学家评估了120份细胞学标本和155份活检标本。细胞学标本总体一致性的加权kappa值为0.54（95%置信区间[CI]，0.49 - 0.59），活检标本为0.59（95%CI，0.55 - 0.63）。病理学家之间两两一致性的中位数kappa值以及与共识的一致性，细胞学分别为0.69和0.77，活检为0.66和0.75。至少3名病理学家对92份（76.7%）细胞学标本和134份（86.5%）活检标本达成一致。贝塞斯达分类系统的可靠性至少为中等，除了意义不明确的非典型鳞状细胞的细胞学类别（kappa = 0.12）。在29份（48.3%）细胞学标本和47份（76.6%）活检标本中，有共识解释为高级别鳞状上皮内病变（HSIL）的标本，最初被≥3名病理学家解释为HSIL。区分HSIL与非HSIL的与共识一致性的kappa值，细胞学标本范围为0.55至0.88，活检标本为0.76至0.94。