Evans Andrew J, Henry Pauline C, Van der Kwast Theodorus H, Tkachuk Douglas C, Watson Kemp, Lockwood Gina A, Fleshner Neil E, Cheung Carol, Belanger Eric C, Amin Mahul B, Boccon-Gibod Liliane, Bostwick David G, Egevad Lars, Epstein Jonathan I, Grignon David J, Jones Edward C, Montironi Rodolfo, Moussa Madeleine, Sweet Joan M, Trpkov Kiril, Wheeler Thomas M, Srigley John R
Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada.
Am J Surg Pathol. 2008 Oct;32(10):1503-12. doi: 10.1097/PAS.0b013e31817fb3a0.
Accurate Gleason score, pathologic stage, and surgical margin (SM) information is critical for the planning of post-radical prostatectomy management in patients with prostate cancer. Although interobserver variability for Gleason score among urologic pathologists has been well documented, such data for pathologic stage and SM assessment are limited. We report the first study to address interobserver variability in a group of expert pathologists concerning extraprostatic soft tissue (EPE) and SM interpretation for radical prostatectomy specimens. A panel of 3 urologic pathologists selected 6 groups of 10 slides designated as being positive, negative, or equivocal for either EPE or SM based on unanimous agreement. Twelve expert urologic pathologists, who were blinded to the panel diagnoses, reviewed 40x whole-slide scans and provided diagnoses for EPE and SM on each slide. On the basis of panel diagnoses, as the gold standard, specificity, sensitivity, and accuracy values were high for both EPE (87.5%, 95.0%, and 91.2%) and SM (97.5%, 83.3%, and 90.4%). Overall kappa values for all 60 slides were 0.74 for SM and 0.63 for EPE. The kappa values were higher for slides with definitive gold standard EPE (kappa=0.81) and SM (kappa=0.73) diagnoses when compared with the EPE (kappa=0.29) and SM (kappa=0.62) equivocal slides. This difference was markedly pronounced for EPE. Urologic pathologists show good to excellent agreement when evaluating EPE and SM. Interobserver variability for EPE and SM interpretation was principally related to the lack of a clearly definable prostatic capsule and crush/thermal artifact along the edge of the gland, respectively.
准确的Gleason评分、病理分期和手术切缘（SM）信息对于前列腺癌患者根治性前列腺切除术后的管理规划至关重要。尽管泌尿外科病理学家之间Gleason评分的观察者间变异性已有充分记录，但关于病理分期和SM评估的此类数据有限。我们报告了第一项针对一组专家病理学家在前列腺根治性切除标本的前列腺外软组织（EPE）和SM解读方面的观察者间变异性的研究。由3名泌尿外科病理学家组成的小组根据一致意见，选择了6组每组10张的切片，这些切片被指定为EPE或SM阳性、阴性或可疑。12名对小组诊断不知情的专家泌尿外科病理学家审查了40倍的全切片扫描，并对每张切片的EPE和SM进行诊断。以小组诊断作为金标准，EPE（87.5%、95.0%和91.2%）和SM（97.5%、83.3%和90.4%）的特异性、敏感性和准确性值都很高。所有60张切片的总体kappa值，SM为0.74，EPE为0.63。与EPE（kappa = 0.29）和SM（kappa = 0.62）可疑切片相比，具有明确金标准EPE（kappa = 0.81）和SM（kappa = 0.73）诊断的切片的kappa值更高。这种差异在EPE方面尤为明显。泌尿外科病理学家在评估EPE和SM时表现出良好到极佳的一致性。EPE和SM解读的观察者间变异性分别主要与缺乏清晰可定义的前列腺包膜以及腺体边缘的挤压/热伪像有关。
