Department of Pathology, Hacettepe University, Ankara, Turkey.
Mod Pathol. 2012 Jun;25(6):877-84. doi: 10.1038/modpathol.2011.220. Epub 2012 Feb 3.
Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.
子宫内膜上皮内瘤变 (EIN) 采用特定的诊断标准来指定一种从先前的研究中已知的单克隆子宫内膜前浸润性腺体增生，其患子宫内膜癌的风险增加了 45 倍。在这项国际研究中，我们评估了 20 名不同实践环境、经验和培训水平的病理学家对 EIN 诊断的准确性和精密度。62 例子宫内膜活检由两位专家亚专科病理学家共识诊断为良性、EIN 或腺癌，作为参考比较，以评估 20 名审查病理学家的诊断准确性。20 名审查者之间的观察者间再现性提供了诊断精度的衡量标准。在评估病例之前，观察者通过审查已发表的教科书和/或在线 EIN 诊断指南进行自我培训。记录了审查病理学家的人口统计学特征及其对 EIN 术语实施的印象。20 名审查病理学家的诊断中有 79%与专家共识完全一致（准确性）。专家共识与每位审查病理学家之间 3 级 EIN 方案（良性、EIN、癌）诊断的观察者间加权κ值平均为 0.72（再现性或精密度）。审查病理学家表现出三种诊断风格之一，其常见诊断的组合不同，并且对潜在的混杂诊断特征（如子宫内膜息肉、分化改变、背景激素效应和技术差的制剂）的反应也不同。EIN 诊断策略可以从标准教学材料中学习和实施，具有高度的可重复性，但受到每位病理学家对潜在诊断混杂因素的个人诊断风格的影响。
