Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Mod Pathol. 2011 Jul;24(7):892-8. doi: 10.1038/modpathol.2011.50. Epub 2011 Apr 15.
The objective of this study is to measure interobserver variability in the classification of laryngeal mucosal premalignant lesions by reassessing the histopathology of previously diagnosed cases and to determine the possible therapeutic consequences of disagreement among observers. Histopathological assessment of 110 laryngeal mucosal premalignant lesions was done by three pathologists. Each slide had to be classified according to the World Health Organization, Squamous Intraepithelial Neoplasia, and the Ljubljana Squamous Intraepithelial Lesions systems. After the independent assessment, a joint meeting took place. To assess the relation between histopathological grading and subsequent clinical management, we created a two- and a three-grade system besides one comprising all options. For all analyses, the SAS/STAT statistical software was used. The highest unweighted κ-values concerning the all-options system are observed for the Squamous Intraepithelial Neoplasia classification (0.28, 95% confidence interval 0.23-0.33), followed by the World Health Organization and Ljubljana classifications. For the two-grade system the Ljubljana classification shows the highest unweighted κ-values (0.50, 95%, 0.39-0.61), followed by the World Health Organization and Squamous Intraepithelial Neoplasia classifications. For the three-grade system, the unweighted κ-values are similar. The implementation of weighted κ-values led to higher scores within all three classification systems, although these did not exceed 0.55 (moderate agreement). Given the high level of consensus, simultaneous pathological assessment may be said to provide added value in comparison with independent assessment. In the current study, no clear tendency is observed in favor of any one classification system. The proposed three-grade system could be an improved histopathological tool because it is easier to correlate with clinical decision making and because it yields better unweighted κ-values and proportions of concordance than the all-options system. Furthermore, clinical management could benefit from assessment by more than one pathologist in suspected cases of dysplasia or carcinoma.
本研究旨在通过重新评估先前诊断病例的组织病理学来衡量喉黏膜癌前病变分类的观察者间变异性，并确定观察者间分歧的可能治疗后果。三位病理学家对 110 例喉黏膜癌前病变的组织病理学进行了评估。每个幻灯片都必须根据世界卫生组织、鳞状上皮内瘤变和卢布尔雅那鳞状上皮内病变系统进行分类。独立评估后，举行了一次联席会议。为了评估组织病理学分级与后续临床管理之间的关系，我们创建了一个两级和三级系统，以及一个包含所有选项的系统。所有分析均使用 SAS/STAT 统计软件进行。关于所有选项系统，加权κ 值最高的是鳞状上皮内瘤变分类（0.28，95%置信区间 0.23-0.33），其次是世界卫生组织和卢布尔雅那分类。对于两级系统，卢布尔雅那分类显示出最高的加权 κ 值（0.50，95%，0.39-0.61），其次是世界卫生组织和鳞状上皮内瘤变分类。对于三级系统，加权 κ 值相似。在所有三个分类系统中，实施加权 κ 值都会导致分数提高，尽管这些分数均未超过 0.55（中等一致性）。鉴于高度共识，可以说与独立评估相比，同时进行病理评估具有附加值。在本研究中，没有观察到任何一种分类系统明显倾向于某种分类系统的趋势。所提出的三级系统可能是一种改进的组织病理学工具，因为它更容易与临床决策相关联，并且由于它比所有选项系统产生更好的未加权 κ 值和一致性比例。此外，在怀疑存在发育不良或癌的病例中，由多位病理学家进行评估可能会使临床管理受益。
