Unidad Reproducción, UGC de Laboratorio Clínico y UGC Obstetricia y Ginecología, HU Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (ibs.granada), C/ Dr. Azpitarte, s/n, 18014 Granada, Spain.
Clínica IFEM, C/ María Teresa de León, s/n, 14005 Córdoba, Spain.
Reprod Biomed Online. 2018 Mar;36(3):259-268. doi: 10.1016/j.rbmo.2017.12.008. Epub 2017 Dec 29.
An external quality-control programme for morphology-based embryo quality assessment, incorporating a standardized embryo grading scheme, was evaluated over a period of 5 years to determine levels of inter-observer reliability and agreement between practising clinical embryologists at IVF centres and the opinions of a panel of experts. Following Guidelines for Reporting Reliability and Agreement Studies, the Gwet index and proportion of positive (Ppos) and negative agreement were calculated. For embryo morphology assessment, a substantial degree of reliability was measured between the centres and the panel of experts (Gwet index: 0.76; 95% CI 0.70 to 0.84). The agreement was higher for good- versus poor-quality embryos. When multinucleation or vacuoles were observed, low levels of reliability were obtained (Ppos: 0.56 and 0.43, respectively). In blastocysts, the characteristic that presented the largest discrepancy was that related to the inner cell mass. In decisions about the final disposition of the embryo, reliability between centre and the panel of experts was moderate (Gwet index: 0.51; 95% CI 0.41 to 0.60). In conclusion, the ability of clinical embryologists to evaluate the presence of multinucleation and vacuoles in the early cleavage embryo, and to determine the category of the inner cell mass in blastocysts, needs to be improved.
一个基于形态学的胚胎质量评估的外部质量控制方案，纳入了标准化的胚胎分级方案，在五年的时间里进行了评估，以确定在体外受精中心工作的临床胚胎学家之间的观察者间可靠性和一致性水平，以及专家组的意见。根据可靠性和一致性研究报告指南，计算了 Gwet 指数和阳性（Ppos）和阴性一致性的比例。对于胚胎形态评估，中心和专家组之间存在相当大的可靠性（Gwet 指数：0.76；95%CI 0.70 至 0.84）。对于优质胚胎和劣质胚胎，其一致性更高。当观察到多核或空泡时，可靠性水平较低（Ppos：分别为 0.56 和 0.43）。在囊胚中，内细胞团与特征差异最大。在胚胎最终处置的决策中，中心和专家组之间的可靠性为中等（Gwet 指数：0.51；95%CI 0.41 至 0.60）。总之，临床胚胎学家评估早期卵裂胚胎多核和空泡的存在，以及确定囊胚内细胞团的分类的能力需要提高。
