Dalla Palma Paolo, Giorgi Rossi Paolo, Collina Guido, Buccoliero Anna Maria, Ghiringhello Bruno, Gilioli Eliana, Onnis Gian Libero, Aldovini Daniela, Galanti Giuseppe, Casadei Gianpiero, Aldi Mirella, Gomes Vito V, Giubilato Pamela, Ronco Guglielmo
Pathology Unit, S Chiara Hospital of Trento, Trento, Italy.
Am J Clin Pathol. 2009 Jul;132(1):125-32. doi: 10.1309/AJCPBRK7D1YIUWFP.
The reproducibility of cervical histology diagnoses is critical for efficient screening and to evaluate the effectiveness of new technologies. The vast majority of cervical intraepithelial neoplasia (CIN) diagnoses reported in the New Technologies for Cervical Cancer study were blindly reviewed by 2 independent pathologists. Only H&E-stained slides were used for the review. The reviewers were asked to reclassify cases using the following categories: normal CIN 1, CIN 2, CIN 3, and squamous and glandular invasive cancer. We reviewed 1,003 cases. The interobserver agreement was 0.36 (95% confidence interval [CI], 0.32-0.40) with an unweighted kappa and 0.54 with a weighted kappa (95% CI, 0.50-0.58). The kappa values from dichotomous classifications with the threshold at CIN 2 were 0.69 (95% CI, 0.64-0.73) and 0.57 (95% CI, 0.51-0.63) with the threshold at CIN 3. The CIN 2 diagnosis had the lowest class-specific agreement, with fewer than 50% of cases confirmed by the panel members, which supports the fact that CIN 2 is not a well-defined stage in the pathogenesis of cervical neoplasia.
宫颈组织学诊断的可重复性对于高效筛查和评估新技术的有效性至关重要。在宫颈癌新技术研究中报告的绝大多数宫颈上皮内瘤变（CIN）诊断均由2名独立病理学家进行盲法复审。复审仅使用苏木精和伊红（H&E）染色的玻片。要求复审人员使用以下类别对病例进行重新分类：正常、CIN 1、CIN 2、CIN 3以及鳞状和腺性浸润癌。我们复审了1003例病例。观察者间一致性在未加权kappa值时为0.36（95%置信区间[CI]，0.32 - 0.40），加权kappa值时为0.54（95%CI，0.50 - 0.58）。以CIN 2为阈值的二分法分类的kappa值为0.69（95%CI，0.64 - 0.73），以CIN 3为阈值时为0.57（95%CI，0.51 - 0.63）。CIN 2诊断的类别特异性一致性最低，专家组成员确认的病例不到50%，这支持了CIN 2在宫颈肿瘤发病机制中不是一个明确界定阶段的事实。
