Nedved Drew, Tonkovic-Capin Viseslav, Hunt Edgar, Zaidi Nasir, Kucenic Michael J, Graves Jeffery J, Fraga Garth R
Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
J Cutan Pathol. 2014 Jan;41(1):9-13. doi: 10.1111/cup.12256. Epub 2013 Nov 14.
There are numerous subtypes of basal cell carcinoma (BCC). Defining the histopathologic subtype is an essential element in patient management, but there is little known data regarding interobserver precision in subtyping BCC.
We studied interobserver variance between six board-certified dermatopathologists who subtyped 100 BCCs in a blinded fashion. We used kappa statistic to calculate the concordance in suggested subtype by different dermatopathologists. Provided diagnoses were then re-categorized into low-risk and high-risk phenotypes, and kappa statistic for concordance on high-risk BCC was determined.
The overall κ statistic was 0.301, indicating fair agreement among the six observers. Superficial and fibroepithelial BCC had the highest individual kappa statistics. When subtypes were re-classified into a two-tier system of high-risk and low-risk phenotypes, there was substantial interobserver agreement on high-risk BCC with a κ statistic of 0.699.
These results suggest only fair agreement among dermatopathologists on specific BCC subtypes, but substantial agreement on superficial, fibroepithelial and high-risk BCC growth patterns. A simplified classification system comprised of superficial, fibroepithelial, nodular and infiltrative subtypes would increase interobserver precision and facilitate clinical decision-making.
基底细胞癌（BCC）有众多亚型。确定组织病理学亚型是患者管理中的一个重要因素，但关于BCC亚型分类中观察者间的精确性，已知数据很少。
我们研究了六位获得委员会认证的皮肤病理学家之间的观察者间差异，他们以盲法对100例BCC进行亚型分类。我们使用kappa统计量来计算不同皮肤病理学家所建议的亚型之间的一致性。然后将所提供的诊断重新分类为低风险和高风险表型，并确定高风险BCC一致性的kappa统计量。
总体κ统计量为0.301，表明六位观察者之间的一致性一般。浅表型和纤维上皮型BCC的个体kappa统计量最高。当亚型被重新分类为高风险和低风险表型的两级系统时，观察者间对高风险BCC有高度一致性，κ统计量为0.699。
这些结果表明，皮肤病理学家对特定BCC亚型的一致性一般，但对浅表型、纤维上皮型和高风险BCC生长模式有高度一致性。一个由浅表型、纤维上皮型、结节型和浸润型亚型组成的简化分类系统将提高观察者间的精确性并促进临床决策。
