German Alyn L, Fleming Kenneth, Kaye Philip, Davies Susan, Goldin Robert, Hubscher Stefan G, Tiniakos Dina, McGregor Angus, Wyatt Judith I
Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK.
Green Templeton College, Oxford University, Oxford, UK.
J Clin Pathol. 2018 Apr;71(4):368-371. doi: 10.1136/jclinpath-2017-204760. Epub 2017 Nov 10.
Staging of fibrosis in medical liver biopsies has inherent interobserver variability. There are a number of disease-specific scoring systems available. While recognising the importance of these scoring systems, there is scope to consider how concordance amongst histopathologists could be improved using a generic fibrosis staging system.Using virtual slides, we approached both specialist liver histopathologists and general histopathologists from the UK to assess the degree of fibrosis against a proposed four-tiered reporting system. Example reference images were then produced and distributed to the same responders who were asked to rate a second set of slides to assess if the use of reference images improved concordance between pathologists.The use of reference images eliminated spread across three categories (from 15% to 0%). Overall, agreement was already good; our study showed an improved agreement amongst all participants for percentage agreement (67.79% to 70.08%) and interobserver agreement improved (Fleiss' Kappa 0.55 to 0.59).
医学肝脏活检中纤维化的分期存在固有的观察者间差异。有许多针对特定疾病的评分系统。虽然认识到这些评分系统的重要性，但仍有空间考虑如何使用通用的纤维化分期系统来提高组织病理学家之间的一致性。我们利用虚拟切片，邀请了英国的肝脏组织病理学专家和普通组织病理学家，根据一个提议的四级报告系统评估纤维化程度。然后制作了示例参考图像并分发给相同的应答者，要求他们对第二组切片进行评分，以评估参考图像的使用是否提高了病理学家之间的一致性。参考图像的使用消除了三个类别的差异（从15%降至0%）。总体而言，一致性原本就良好；我们的研究表明，所有参与者在百分比一致性方面的一致性有所提高（从67.79%提高到70.08%），观察者间一致性也有所提高（Fleiss' Kappa从0.55提高到0.59）。
