Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Hum Pathol. 2011 Jan;42(1):68-74. doi: 10.1016/j.humpath.2010.07.001. Epub 2010 Oct 20.
Advances in whole slide digital imaging in the past decade necessitate validation of these tools in each organ system in advance of clinical adoption. We assessed reproducibility in reporting prostate needle biopsy parameters among urologic pathologists using routine and digital microscopy in a consultation/second opinion-like setting. Four urologic pathologists evaluated a single core level from 50 diagnostically challenging needle biopsy specimens by routine microscopy and whole slide digital imaging. Interobserver and intraobserver agreement were calculated for primary and secondary Gleason grades, Gleason score, tumor quantitation (percentage and size in millimeters), and perineural invasion. Interobserver agreement for routine microscopy was excellent for primary Gleason grade (κ = 0.72) and good for all other parameters (κ ranging from 0.36 to 0.55). Whole slide digital imaging assessment yielded similar agreement for all parameters. Intraobserver agreement for primary Gleason grade and Gleason score was very good to excellent for all pathologists (all κ ≥ 0.65 and ≥ 0.73, respectively). Size of tumor in millimeters consistently displayed higher levels of agreement than percentage of tumor across media and pathologists. Digital assessment of routinely reported cancer parameters on prostatic needle biopsy for a given scanned core level is comparable to that of routine microscopy. These findings imply that histologic interpretation using dynamic whole slide images may accurately simulate routine microscopic evaluation in the consultation setting. Implementation of whole slide digital imaging in these scenarios may significantly reduce the workload of large referral centers in the near future and impact the manner in which pathologists seek second opinion consultation on challenging cases.
过去十年中，全玻片数字成像技术取得了进展，因此在将这些工具应用于临床之前，需要在每个器官系统中对其进行验证。我们在咨询/二次诊断的环境下，使用常规显微镜和数字显微镜，评估了泌尿科病理学家在报告前列腺针吸活检参数方面的重复性。四位泌尿科病理学家通过常规显微镜和全玻片数字成像评估了 50 例具有诊断挑战性的针吸活检标本中的单个核心水平。计算了主要和次要 Gleason 分级、Gleason 评分、肿瘤定量（百分比和毫米大小）和神经周围侵犯的观察者间和观察者内一致性。常规显微镜检查的观察者间一致性对于主要 Gleason 分级非常好（κ=0.72），对于所有其他参数也很好（κ 范围为 0.36 至 0.55）。全玻片数字成像评估对于所有参数均产生了相似的一致性。对于所有病理学家，主要 Gleason 分级和 Gleason 评分的观察者内一致性均非常好至优秀（所有 κ≥0.65 和≥0.73）。在所有介质和病理学家中，毫米大小的肿瘤比肿瘤百分比具有更高的一致性。在给定扫描的核心水平上，对前列腺针吸活检中常规报告的癌症参数进行数字评估与常规显微镜检查相当。这些发现表明，使用动态全玻片图像进行组织学解释可能会在咨询环境中准确模拟常规显微镜评估。在这些情况下实施全玻片数字成像可能会在不久的将来大大减少大型转诊中心的工作量，并影响病理学家在具有挑战性的病例中寻求二次诊断咨询的方式。
