Department of Pathology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Virchows Arch. 2011 Jun;458(6):659-64. doi: 10.1007/s00428-011-1072-3. Epub 2011 Apr 12.
The clinical management of tumor patients is often strongly influenced by the tumor grade. The presence of heterogeneity is well recognized in a variety of tumors. Overall grade is based on highest grade area identified within a tumor. Urothelial carcinoma often contains different histological grades within the same tumor. This study investigates the impact of a combined grading system on the reproducibility of papillary urothelial neoplasms. A set prepared for an earlier study consisting of ten cases of each category (papillary urothelial neoplasm of low malignant potential (PUNLMP), LGPUC, and HGPUC) was used. Agreement between pairs of pathologists was evaluated using κ statistics for the combined scoring system. Interobserver agreement was fair to substantial as reflected by κ values ranging from 0.24 to 0.74 (mean κ = 0.43). The combined scores of 2 and 3 which included PUNLMP showed the lowest degree of agreement and when this category was excluded from the analysis, interobserver agreement increased significantly (mean κ = 0.65; ranging from 0.43 to 0.92) in terms of combined scores of 4, 5, and 6. PUNLMP has been shown to be the least reproducible component of a combined scoring system even among experienced observers. Exclusion of PUNLMP from grading scheme seems to improve interobserver variability.
肿瘤患者的临床管理通常受到肿瘤分级的强烈影响。在各种肿瘤中，异质性的存在是众所周知的。总体分级基于肿瘤内确定的最高分级区域。尿路上皮癌通常在同一肿瘤中包含不同的组织学分级。本研究调查了联合分级系统对乳头状尿路上皮肿瘤可重复性的影响。使用了一套为早期研究准备的组织学样本，包括每种类型的 10 例（低恶性潜能乳头状尿路上皮肿瘤 (PUNLMP)、低级别尿路上皮癌 (LGPUC) 和高级别尿路上皮癌 (HGPUC)）。使用 κ 统计量评估了两位病理学家之间的组合评分系统的一致性。κ 值范围为 0.24 至 0.74（平均 κ 值为 0.43），反映了观察者间的一致性为公平至实质性。包括 PUNLMP 的组合评分 2 和 3 显示出最低的一致性，当将该类别从分析中排除时，观察者间的一致性显著增加（平均 κ 值为 0.65；范围为 0.43 至 0.92），即 4、5 和 6 的组合评分。即使在经验丰富的观察者中，PUNLMP 也被证明是联合评分系统中最不可重复的组成部分。将 PUNLMP 从分级方案中排除似乎可以提高观察者间的变异性。
