Fenger C, Bak M, Kronborg O, Svanholm H
Department of Pathology, Odense University Hospital, Denmark.
J Clin Pathol. 1990 Apr;43(4):320-4. doi: 10.1136/jcp.43.4.320.
The two most well known and well defined grading systems for dysplasia in colorectal adenomas were compared with regard to reproducibility. The Konishi-Morson system (KMS) operates with several histological and cytological variables and grades of mild, moderate, and severe dysplasia. The Kozuka system is based on the extent of nuclear pseudostratification and also has three grades of dysplasia (III-V). As the group of severe dysplasia is very large in this system, it was extended with two higher grades, similarly based on individual histological criteria, known hereafter as the extended Kozuka system (EKS). Fifty six adenomas were graded by two observers, each observer grading twice according to the KMS criteria and twice according to EKS criteria. Intraobserver reproducibility was excellent for the KMS and moderate for the EKS, but this was not significant. The overall interobserver reproducibility was similar (moderate) for the KMS and for the EKS. Kappa values for interobserver reproducibility on individual categories were excellent for severe dysplasia according to the KMS, but low for all other categories in both systems. By simplifying both systems into two groups a high reproducibility can be obtained, but this implies that all the original grades (III-V) for the EKS must be grouped together. It is therefore recommended that a simplified KMS is used for further studies on the biological importance of dysplasia and for comparison between histological changes and other markers for colorectal neoplasia.
对结直肠腺瘤发育异常的两种最知名且定义明确的分级系统的可重复性进行了比较。小西-莫森系统（KMS）依据多个组织学和细胞学变量进行操作，分为轻度、中度和重度发育异常等级。小冢系统基于核假复层的程度，也有三个发育异常等级（III - V）。由于该系统中重度发育异常组非常大，在此基础上又增加了两个更高等级，同样依据个体组织学标准，此后称为扩展小冢系统（EKS）。由两名观察者对56个腺瘤进行分级，每位观察者根据KMS标准分级两次，根据EKS标准分级两次。观察者内重复性方面，KMS表现出色，EKS为中等，但差异不显著。观察者间总体重复性方面，KMS和EKS相似（中等）。在个体类别上，观察者间重复性的kappa值对于KMS标准下的重度发育异常表现出色，但在两个系统的所有其他类别中均较低。通过将两个系统简化为两组可获得较高的重复性，但这意味着EKS的所有原始等级（III - V）必须合并在一起。因此，建议使用简化的KMS用于进一步研究发育异常的生物学重要性，以及用于比较组织学变化与结直肠肿瘤的其他标志物。
