Rooney Terence, Bresnihan Barry, Andersson Ulf, Gogarty Martina, Kraan Maarten, Schumacher H Ralph, Ulfgren Ann-Kristin, Veale Douglas J, Youssef Peter P, Tak Paul P
Department of Rheumatology, St. Vincent's University Hospital, Dublin 4, Ireland.
Ann Rheum Dis. 2007 Dec;66(12):1656-60. doi: 10.1136/ard.2006.061143. Epub 2007 Jun 29.
To evaluate inter-observer agreement for microscopic measurement of inflammation in synovial tissue using manual quantitative, semiquantitative and computerised digital image analysis.
Paired serial sections of synovial tissue, obtained at arthroscopic biopsy of the knee from patients with rheumatoid arthritis (RA), were stained immunohistochemically for T lymphocyte (CD3) and macrophage (CD68) markers. Manual quantitative and semiquantitative scores for sub-lining layer CD3+ and CD68+ cell infiltration were independently derived in 6 international centres. Three centres derived scores using computerised digital image analysis. Inter-observer agreement was evaluated using Spearman's Rho and intraclass correlation coefficients (ICCs).
Paired tissue sections from 12 patients were selected for evaluation. Satisfactory inter-observer agreement was demonstrated for all 3 methods of analysis. Using manual methods, ICCs for measurement of CD3+ and CD68+ cell infiltration were 0.73 and 0.73 for quantitative analysis and 0.83 and 0.78 for semiquantitative analysis, respectively. Corresponding ICCs of 0.79 and 0.58 were observed for the use of digital image analysis. All ICCs were significant at levels of p<0.0001. At each participating centre, use of computerised image analysis produced results that correlated strongly and significantly with those obtained using manual measurement.
Strong inter-observer agreement was demonstrated for microscopic measurement of synovial inflammation in RA using manual quantitative, semiquantitative and computerised digital methods of analysis. This further supports the development of these methods as outcome measures in RA.
使用手动定量、半定量和计算机数字图像分析评估滑膜组织炎症微观测量的观察者间一致性。
从类风湿性关节炎（RA）患者膝关节关节镜活检获取的滑膜组织配对连续切片，进行免疫组织化学染色以检测T淋巴细胞（CD3）和巨噬细胞（CD68）标志物。6个国际中心独立得出滑膜下层CD3+和CD68+细胞浸润的手动定量和半定量评分。3个中心使用计算机数字图像分析得出评分。使用Spearman秩相关系数和组内相关系数（ICC）评估观察者间一致性。
选取12例患者的配对组织切片进行评估。所有3种分析方法均显示出令人满意的观察者间一致性。使用手动方法，定量分析中CD3+和CD68+细胞浸润测量的ICC分别为0.73和0.73，半定量分析中分别为0.83和0.78。使用数字图像分析时相应的ICC为0.79和0.58。所有ICC在p<0.0001水平均具有显著性。在每个参与中心，使用计算机图像分析得出的结果与使用手动测量得出的结果高度显著相关。
使用手动定量、半定量和计算机数字分析方法对RA滑膜炎症进行微观测量显示出很强的观察者间一致性。这进一步支持将这些方法开发为RA的结局指标。
