Mamoon Nadira, Iqbal Muhammad Ashraf, Jamal Shahid, Luqman Muhammad
Department of Histopathology, Armed Forces Institute of Pathology Rawalpindi, Pakistan.
J Ayub Med Coll Abbottabad. 2006 Apr-Jun;18(2):4-8.
Classification of urothelial bladder tumours is an important factor in the treatment and prognosis of these lesions. Over the years many classifications have been proposed for this purpose. The objective of this study was to classify urothelial neoplasms of the urinary bladder using the latest WHO/ISUP Consensus Classification 1998 and WHO Classification 1972 and compare the two regarding interobserver variability.
This study included 100 consecutive biopsy specimens of urothelial neoplasms of the urinary bladder diagnosed at the department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. These were classified according to WHO Classification 1972 and WHO/ISUP Consensus Classification 1998 by 2 groups of pathologists independently. The tumour categories for WHO classification 1972; papilloma, and transitional cell carcinoma (TCC) grades I, II and III were compared with the WHO/ISUP Consensus Classification entities of papilloma, papillary neoplasm of low malignant potential, low grade and high grade papillary carcinomas. Kappa statistics were used to evaluate interobserver variability. Chi square test was used to calculate significance.
There was agreement on 80 tumours between the two groups of histopathologists when using WHO classification 1972 while there was agreement on 95 tumours using WHO/ISUP consensus classification. The value of Kappa for WHO Classification was 0.68 (good agreement) whereas for WHO/ISUP Consensus Classification it was 0.91 (excellent agreement). The difference between the two systems was statistically significant (p<0,001). Kappa values were less for benign and borderline lesions using both systems.
WHO/ISUP Consensus Classification 1998 showed less interobserver variability than WHO Classification 1972 in the evaluation of bladder tumours. It was found easier to apply by both groups. There was less agreement on the benign and borderline lesions using both the classifications.
尿路上皮膀胱肿瘤的分类是这些病变治疗和预后的重要因素。多年来，为此目的提出了许多分类方法。本研究的目的是使用最新的世界卫生组织/国际泌尿病理学会1998年共识分类和1972年世界卫生组织分类对膀胱尿路上皮肿瘤进行分类，并比较两者在观察者间变异性方面的差异。
本研究纳入了拉瓦尔品第武装部队病理研究所组织病理学部门诊断的100例连续的膀胱尿路上皮肿瘤活检标本。由两组病理学家分别根据1972年世界卫生组织分类和1998年世界卫生组织/国际泌尿病理学会共识分类进行分类。将1972年世界卫生组织分类的肿瘤类别（乳头状瘤、I级、II级和III级移行细胞癌）与世界卫生组织/国际泌尿病理学会共识分类的乳头状瘤、低恶性潜能乳头状肿瘤、低级别和高级别乳头状癌实体进行比较。使用Kappa统计量评估观察者间变异性。使用卡方检验计算显著性。
使用1972年世界卫生组织分类时，两组组织病理学家对80例肿瘤的分类一致，而使用世界卫生组织/国际泌尿病理学会共识分类时，对95例肿瘤的分类一致。1972年世界卫生组织分类的Kappa值为0.68（良好一致性），而世界卫生组织/国际泌尿病理学会共识分类的Kappa值为0.91（极好一致性）。两种分类系统之间的差异具有统计学显著性（p<0.001）。使用两种分类系统时，良性和交界性病变的Kappa值较低。
在膀胱肿瘤评估中，1998年世界卫生组织/国际泌尿病理学会共识分类显示出比1972年世界卫生组织分类更小的观察者间变异性。两组都发现它更容易应用。两种分类在良性和交界性病变上的一致性较低。
