Layfield Lester J, Esebua Magda, Frazier Shellaine R, Hammer Richard D, Bivin William W, Nguyen Van, Ersoy Ilker, Schmidt Robert L
Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri.
Department of Pathology and Laboratory Medicine/ARUP Laboratories, Salt Lake City, Utah.
Diagn Cytopathol. 2017 Feb;45(2):107-112. doi: 10.1002/dc.23639.
Evaluation of the nuclear to cytoplasmic ratio is commonly used for assessment of the presence of malignancy and for grading and typing of malignant neoplasms. Despite its widespread usage, little information exists regarding the accuracy and reproducibility of non-automated assessment.
Forty-seven cells obtained from Papanicolaou stained urine cytologies were assessed by quantitative image analysis for nuclear area and cell area. The nuclear/cytoplasmic ratio was calculated. Visual estimates of the N/C ratio were made by six pathologists. Statistical analysis was performed to determine accuracy, precision, and interrater reliability.
True N/C ratios varied from 0.02 to 0.81. 27% of cases demonstrated a true N/C ratio between 0.5 and 0.7. Quantitative estimates of N/C ratios were less precise and less accurate at high N/C ratios. The coefficient of variation was 27%. The majority of raters demonstrated decreased accuracy and precision of estimates as N/C ratio increased. Overall classification accuracy was 73%. Accuracy of classification was 53% for cases with a true N/C ratio between 0.4 and 0.8. Absolute interrater agreement was 75%. Chance corrected agreement (kappa) was 0.54.
Visual quantitation of N/C ratio showed only a fair correlation with actual N/C ratio with correlation decreasing with increasing N/C ratio. In the critical range, 0.5-0.7 N/C ratio both interobserver correlation and correlation with true N/C ratio may be insufficiently accurate for precise category assignment as used in the Paris System. Diagn. Cytopathol. 2017;45:107-112. © 2016 Wiley Periodicals, Inc.
核质比评估常用于恶性肿瘤的诊断以及恶性肿瘤的分级和分型。尽管其应用广泛，但关于非自动化评估的准确性和可重复性的信息却很少。
通过定量图像分析对47例巴氏染色尿细胞学检查获得的细胞进行核面积和细胞面积评估。计算核质比。由六位病理学家对核质比进行视觉估计。进行统计分析以确定准确性、精密度和观察者间的可靠性。
真实核质比在0.02至0.81之间。27%的病例显示真实核质比在0.5至0.7之间。在高核质比时，核质比的定量估计精度较低且准确性较差。变异系数为27%。随着核质比增加，大多数观察者的估计准确性和精度下降。总体分类准确率为73%。真实核质比在0.4至0.8之间的病例分类准确率为53%。观察者间的绝对一致性为75%。机遇校正一致性（kappa）为0.54。
核质比的视觉定量与实际核质比仅呈现出一般的相关性，且随着核质比增加相关性降低。在关键范围（核质比为0.5 - 0.7）内，观察者间的相关性以及与真实核质比的相关性可能不够准确，无法像巴黎系统那样进行精确的类别划分。《诊断细胞病理学》2017年；45:107 - 112。© 2016威利期刊公司
