Ismail S M, Colclough A B, Dinnen J S, Eakins D, Evans D M, Gradwell E, O'Sullivan J P, Summerell J M, Newcombe R
Department of Histopathology, University Hospital of Wales, Heath Park, Cardiff, UK.
Histopathology. 1990 Apr;16(4):371-6. doi: 10.1111/j.1365-2559.1990.tb01141.x.
Eight histopathologists, based at different hospitals, who had previously examined 100 consecutive colposcopic cervical biopsies were circulated with the results of the initial study. The slides were then 'reblinded' and re-examined by the pathologists who, as before, assigned them into one of six diagnostic categories. The degree of interpathologist agreement for the seven observers who returned usable responses was characterized by kappa statistics and compared to the corresponding figures for the same observers from the previous study. Although some of the observers showed significant alterations in their diagnostic practices there was persistent poor agreement for CIN 1 and 2, mediocre agreement for CIN 3 and excellent agreement for invasive carcinoma. Intra-observer agreement was consistently better than inter-observer agreement for each of the diagnostic categories. Significant differences were found among observers in the degree of intra-observer variability. The 20 cases in which there was most disagreement were re-examined by one of the authors who compared these with 20 biopsies which caused little disagreement. Disagreement was considered to be associated with florid papilloma-virus changes, basal cell hyperplasia and severe inflammation in varying combinations. On the basis of these findings we suggest changes in the terminology of CIN lesions.
八位来自不同医院的组织病理学家收到了初步研究的结果，他们之前曾检查过100例连续的阴道镜下宫颈活检样本。然后，病理学家们将切片“重新设盲”并重新检查，像之前一样，将它们归入六个诊断类别之一。用kappa统计量描述了七位给出可用回复的观察者之间的一致性程度，并与他们在之前研究中的相应数据进行了比较。尽管一些观察者的诊断方法有显著改变，但对于CIN 1和2的一致性仍然很差，对于CIN 3的一致性一般，对于浸润癌的一致性很好。在每个诊断类别中，观察者内部的一致性始终优于观察者之间的一致性。观察者之间在观察者内部变异性程度上存在显著差异。其中分歧最大的20个病例由一位作者重新检查，作者将这些病例与20个分歧较小的活检样本进行了比较。分歧被认为与不同组合的典型乳头瘤病毒改变、基底细胞增生和严重炎症有关。基于这些发现，我们建议对CIN病变的术语进行更改。
