Gunia Sven, Burger Maximilian, Hakenberg Oliver W, May Dieter, Koch Stefan, Jain Anjun, Birnkammer Kristina, Wieland Wolf F, Otto Wolfgang, Hofstädter Ferdinand, Fritsche Hans-Martin, Denzinger Stefan, Gilfrich Christian, Brookman-May Sabine, May Matthias
Institute of Pathology, Johanniter Hospital Stendal, Stendal, Germany. sven-gunia @ gmx.de
Urol Int. 2013;90(2):207-13. doi: 10.1159/000342639. Epub 2012 Oct 26.
We assessed the reproducibility and prognostic impact of the Broders' grading system (BGS) in a cohort of 147 patients with surgically treated penile squamous cell carcinomas.
Conventionally stained histology slides were graded according to the BGS in two rounds by two study pathologists. Reproducibility was assessed using ĸ statistics. Multivariable analyses were calculated to predict cancer-specific survival (CSS). The 'mean grade' per pathologist per round was calculated by allocating grade points to each study case (G1-G4: 1-4 points) and dividing the sum of all grade points by the number of cases examined.
The BGS showed substantial interobserver variation (59-87% with ĸ = 0.38-0.69) but almost perfect intraobserver reproducibility (91% with ĸ = 0.86 and 96% with ĸ = 0.94, respectively). The 'mean grade' per pathologist remained nearly constant in both rounds of examination (differences ≤0.05 grade points) but differed between the two pathologists (up to 0.4 grade points). In multivariable analyses, the prognostic impact of the BGS in terms of CSS was strongly pathologist-dependent.
Clinically and prognostically relevant interobserver discordance concerning the BGS seems, at least in part, to be attributable to inherent 'aggressive' versus 'reserved' grading characteristics of individual pathologists.
我们评估了Broders分级系统（BGS）在147例接受手术治疗的阴茎鳞状细胞癌患者队列中的可重复性和预后影响。
两名研究病理学家分两轮根据BGS对常规染色的组织学切片进行分级。使用ĸ统计量评估可重复性。进行多变量分析以预测癌症特异性生存率（CSS）。通过为每个研究病例分配分级分数（G1 - G4：1 - 4分），并将所有分级分数的总和除以检查的病例数，计算出每位病理学家每轮的“平均分级”。
BGS显示出观察者间的显著差异（ĸ = 0.38 - 0.69时为59 - 87%），但观察者内的可重复性几乎完美（ĸ = 0.86时为91%，ĸ = 0.94时为96%）。两位病理学家在两轮检查中各自的“平均分级”几乎保持不变（差异≤0.05分级分数），但两位病理学家之间存在差异（高达0.4分级分数）。在多变量分析中，BGS对CSS的预后影响强烈依赖于病理学家。
关于BGS，临床和预后相关的观察者间不一致似乎至少部分归因于个别病理学家固有的“激进”与“保守”分级特征。
