Doutre Sylviane, Omar Tanvier, Goumbri-Lompo Olga, Kelly Helen, Clavero Omar, Zan Souleymane, Chikandiwa Admire, Sawadogo Bernard, Delany-Moretlwe Sinead, Costes Valérie, Mayaud Philippe, Segondy Michel
Department of Biology and Pathology, University Hospital (CHU), Montpellier, France.
Department of Pathology, National Health Laboratory Services Johannesburg, South Africa.
J Clin Pathol. 2018 Jan;71(1):40-45. doi: 10.1136/jclinpath-2017-204512. Epub 2017 Jun 9.
To analyse the effect of the expert end-point committee (EPC) review on histological endpoint classification of cervical intraepithelial neoplasia (CIN).
A cohort of women living with HIV were recruited in Burkina Faso (BF) and South Africa (SA) and followed over 18 months. Four-quadrant cervical biopsies were obtained in women with abnormalities detected by at least one screening test. A central review by a panel of five pathologists was organised at baseline and at endline.
At baseline the prevalence of high-grade CIN (CIN2+) was 5.1% (28/554) in BF and 23.3% (134/574) in SA by local diagnosis, and 5.8% (32/554) in BF and 22.5% (129/574) in SA by the EPC. At endline the prevalence of CIN2+ was 2.3% (11/483) in BF and 9.4% (47/501) in SA by local diagnosis, and 1.4% (7/483) in BF and 10.2% (51/501) in SA by EPC. The prevalence of borderline CIN1/2 cases was 2.8% (32/1128) and 0.8% (8/984) at baseline and endline. Overall agreement between local diagnosis and final diagnosis for distinguishing CIN2+ from ≤CIN1 was 91.2% (κ=0.82) and 88.9% (κ=0.71) for BF at baseline and endline, and 92.7% (κ=0.79) and 98.7% (κ=0.97) for SA at baseline and endline. Among the CIN1/2 cases, 12 (37.5%) were graded up to CIN2 and 20 (62.5%) were graded down to CIN1 at baseline, and 3 (37.5%) were graded up to CIN2 and 5 (62.5%) were graded down to CIN1 at endline.
This study highlights the importance of a centralised rigorous re-reading with exchange of experiences among pathologists from different settings.
分析专家终点委员会（EPC）审查对宫颈上皮内瘤变（CIN）组织学终点分类的影响。
在布基纳法索（BF）和南非（SA）招募了一组感染艾滋病毒的女性，并对其进行了18个月的随访。对至少一项筛查试验检测出异常的女性进行宫颈四象限活检。在基线和终线时组织了由五名病理学家组成的小组进行集中审查。
在基线时，通过当地诊断，BF的高级别CIN（CIN2+）患病率为5.1%（28/554），SA为23.3%（134/574）；通过EPC审查，BF为5.8%（32/554），SA为22.5%（129/574）。在终线时，通过当地诊断，BF的CIN2+患病率为2.3%（11/483），SA为9.4%（47/501）；通过EPC审查，BF为1.4%（7/483），SA为10.2%（51/501）。临界CIN1/2病例在基线和终线时的患病率分别为2.8%（32/1128）和0.8%（8/984）。在BF，基线和终线时区分CIN2+与≤CIN1的当地诊断与最终诊断之间的总体一致性分别为91.2%（κ=0.82）和88.9%（κ=0.71）；在SA，基线和终线时分别为92.7%（κ=0.79）和98.7%（κ=0.97）。在CIN1/2病例中，基线时有12例（37.5%）升级为CIN2，20例（62.5%）降级为CIN1；终线时有3例（37.5%）升级为CIN2，5例（62.5%）降级为CIN1。
本研究强调了集中进行严格重新阅读并在来自不同地区的病理学家之间交流经验的重要性。
