Kasamatsu Elena, Bravo Luis Eduardo, Bravo Juan Carlos, Aguirre-García Jesús, Flores-Luna Lourdes, Nunes-Velloso María del Carmen, Hernández-Suárez Gustavo
Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Asunción, Paraguay.
Salud Publica Mex. 2010 Sep-Oct;52(5):386-90. doi: 10.1590/s0036-36342010000500005.
The aim was to evaluate the concordance in the diagnosis of precursor lesions of intestinal-type gastric carcinoma among observers with different levels of experience.
Gastric biopsies from 1 056 cases were studied: 341 from Colombia, 382 from Mexico, and 333 from Paraguay. Pathologists without experience (A) and with experience (B) in gastrointestinal pathology, as well as experts working in an international reference center (C) participated in the diagnosis of each case.
The concordance (k) between pathologists with experience and those without was poor for the diagnosis of atrophic gastritis (k=0.04 to 0.12) and dysplasia (k=0.11 to 0.05), and good for the diagnosis of intestinal metaplasia (k=0.52 to 0.58). Supervision of pathologists without experience by those with experience remarkably improved the concordance in the diagnosis of atrophic gastritis (k=0.65) and intestinal metaplasia (k=0.91), and to a lesser degree, of dysplasia (k=0.28). The concordance among experts before and after the consensus meeting showed no variation in the diagnosis of atrophic gastritis (k=0.57); the concordance varied from good to excellent in the diagnosis of intestinal metaplasia (k=0.67 to 0.81) and from poor to good in that of dysplasia (k=0.18 to 0.66).
The greatest differences arose in the diagnosis of chronic atrophic gastritis and dysplasia. The interobserver concordance depended on the experience of the observer and the consensus reading.
评估不同经验水平的观察者对肠型胃癌前驱病变诊断的一致性。
对1056例胃活检标本进行研究，其中341例来自哥伦比亚，382例来自墨西哥，333例来自巴拉圭。没有胃肠道病理学经验的病理学家（A）、有经验的病理学家（B）以及在国际参考中心工作的专家（C）参与了每例病例的诊断。
有经验的病理学家与无经验的病理学家在萎缩性胃炎诊断方面的一致性较差（k=0.04至0.12），在发育异常诊断方面的一致性也较差（k=0.11至0.05），而在肠化生诊断方面的一致性良好（k=0.52至0.58）。有经验的病理学家对无经验的病理学家进行监督，显著提高了萎缩性胃炎诊断的一致性（k=0.65）和肠化生诊断的一致性（k=0.91），对发育异常诊断一致性的提高程度较小（k=0.28）。专家们在共识会议前后的一致性显示，萎缩性胃炎诊断的一致性没有变化（k=0.57）；肠化生诊断的一致性从良好到优秀（k=0.67至0.81），发育异常诊断的一致性从较差到良好（k=0.18至0.66）。
慢性萎缩性胃炎和发育异常的诊断差异最大。观察者之间的一致性取决于观察者的经验和共识解读。
