From the Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Funkhouser Jr and Banks); Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, North Carolina (Drs Funkhouser Jr, Hayes, Nikolaishvilli-Feinberg, and Grilley-Olson; Messrs Moore and Jo; and Ms Eeva); the Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina (Drs Hayes and Grilley-Olson); the Department of Computer Sciences, University of Wisconsin, Madison (Mr Funkhouser III); the Department of Biostatistics, UNC School of Public Health, Chapel Hill, North Carolina (Dr Fine); Medical Affairs, Ventana Medical Systems, Tucson, Arizona (Dr Banks); Unit of Pathology, Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy (Dr Graziano); the Department of Pathology, VA Medical Center, Durham, North Carolina (Dr Boswell); the Department of Medical Biosciences, Pathology, Umeå University Hospital, Umeå, Sweden (Dr Elmberger); the Department of Pathology, Kaiser-Permanente Hospital, Santa Clara, California (Dr Raparia); the Department of Pathology, Piedmont Medical Center, Rock Hill, South Carolina (Dr Hart); the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Sholl); the Department of Pathology, Suburban Hospital, Bethesda, Maryland (Dr Nolan); the Department of Pathology, Mayo Clinic, Rochester, Minnesota (Dr Fritchie); the Department of Pathology, VA Medical Center, Dayton, Ohio (Dr Pouagare); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Rex Hospital, Raleigh, North Carolina (Dr Volmar); the Department of Pathology, Medical College of Georgia, Augusta (Drs Biddinger and Kleven); the Department of Pathology, Flagstaff Medical Center, Flagstaff, Arizona (Dr Papez); the Department of Pathology, VA Medical Center, Charleston, South Carolina (Dr Spencer); the Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Rekhtman); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Mino-Kenudson and Hariri); and the Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Driver and Cagle). Dr Allen is currently located at the Department of Pathology at University of Mississippi Medical Center, Jackson.
Arch Pathol Lab Med. 2018 Dec;142(12):1537-1548. doi: 10.5858/arpa.2017-0481-OA. Epub 2018 Apr 30.
CONTEXT.—: Measurement of interpathologist diagnostic agreement (IPDA) should allow pathologists to improve current diagnostic criteria and disease classifications.
OBJECTIVES.—: To determine how IPDA for pathologists' diagnoses of non-small cell lung carcinoma (NSCLC) is affected by the addition of a set of mucin and immunohistochemical (IHC) stains to hematoxylin-eosin (H&E) alone, by recent NSCLC reclassifications, by simplification of these classifications, and by pathologists' practice location, pulmonary pathology expertise, practice duration, and lung carcinoma case exposure.
DESIGN.—: We used a Web-based survey to present core images of 54 NSCLC cases to 22 practicing pathologists for diagnosis, initially as H&E only, then as H&E plus mucin and 4 IHC stains. Each case was diagnosed according to published 2004, 2011, and 2015 NSCLC classifications. Cohen's kappa was calculated for the 231 pathologist pairs as a measure of IPDA.
RESULTS.—: Twenty-two pathologists diagnosed 54 NSCLC cases by using 4 published classifications. IPDA is significantly higher for H&E/mucin/IHC diagnoses than for H&E-only diagnoses. IPDA for H&E/mucin/IHC diagnoses is highest with the 2015 classification. IPDA is estimated higher after collapse of stated diagnoses into subhead or dichotomized classes. IPDA for H&E/mucin/IHC diagnoses with the 2015 World Health Organization classification is similar for community and academic pathologists, and is higher when pathologists have pulmonary pathology expertise, have more than 6 years of practice experience, or diagnose more than 100 new lung carcinoma cases per year.
CONCLUSIONS.—: Higher IPDA is associated with use of mucin and IHC stains, with the 2015 NSCLC classification, and with pathologists' pulmonary pathology expertise, practice duration, and frequency of lung carcinoma cases.
衡量病理学家间诊断一致性（IPDA）可使病理学家改进当前的诊断标准和疾病分类。
确定非小细胞肺癌（NSCLC）病理学家诊断的 IPDA 如何受以下因素影响：在单独使用苏木精和伊红（H&E）的基础上增加一组黏蛋白和免疫组织化学（IHC）染色、最近的 NSCLC 重新分类、这些分类的简化，以及病理学家的执业地点、肺病理学专业知识、执业年限和肺癌病例接触情况。
我们使用基于网络的调查，向 22 名执业病理学家展示了 54 例 NSCLC 核心图像，供其进行诊断，最初仅使用 H&E，然后使用 H&E 加黏蛋白和 4 种 IHC 染色。根据 2004 年、2011 年和 2015 年 NSCLC 分类标准对每个病例进行诊断。计算了 231 对病理学家的 Cohen's kappa 值，作为 IPDA 的衡量指标。
22 名病理学家使用 4 种发表的分类标准诊断了 54 例 NSCLC 病例。与仅使用 H&E 相比，使用 H&E/黏蛋白/IHC 进行诊断的 IPDA 明显更高。使用 2015 年分类标准时，IPDA 最高。将诊断结果归入子标题或二分类别后，IPDA 估计更高。使用 2015 年世界卫生组织分类标准时，H&E/黏蛋白/IHC 诊断的 IPDA 对于社区和学术病理学家相似，当病理学家具有肺病理学专业知识、实践经验超过 6 年或每年诊断超过 100 例新肺癌病例时，IPDA 更高。
更高的 IPDA 与使用黏蛋白和 IHC 染色、2015 年 NSCLC 分类以及病理学家的肺病理学专业知识、实践年限和肺癌病例频率有关。
