Wu Xian-Rui, Liu Hua-Shan, Shi Xue-Ying, Zhou Wei-Xun, Jiang Zhi-Nong, Huang Yan, Karamchandani Dipti M, Goldblum John R, Xiao Shu-Yuan, Zhu Hong-Fa, Feely Michael M, Collinsworth Amy L, Esnakula Ashwini, Xie Hao, Shen Bo, Lan Ping, Liu Xiu-Li
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Pathology, Peking University Third Hospital, Beijing, China.
Gastroenterol Res Pract. 2018 Apr 23;2018:8715263. doi: 10.1155/2018/8715263. eCollection 2018.
The aim of this study was to evaluate the interobserver variability in diagnosing inflammatory bowel disease (IBD)-associated neoplasia among practicing pathologists from China using telepathology, a practice of remote diagnostic consultation increasingly used nationally and internationally, and its comparison with the interpretation of subspecialized gastrointestinal (GI) pathologists from the United States (US).
Eight GI pathologists from the US and 4 pathologists from China with an interest in GI pathology participated in this study. A total of 50 colonic biopsies from patients with a clinical history of IBD from 8 medical centers in China were included. All microscopic slides in each case were digitized using an Aperio system. One pathologist (XL) reviewed the digitized full-slide images, and selected areas of interest were captured at low, medium, and high magnifications at a resolution of 1712 × 1072 pixels and saved as tagged image file format (TIFF) files on read-only DVD. Each pathologist evaluated the images and selected the most appropriate diagnostic category for each case (negative, indefinite, low-grade dysplasia [LGD], high-grade dysplasia [HGD], and carcinoma). A Fleiss' kappa coefficient () analysis was performed to determine interobserver agreement and the agreement of each pathologist from China with the consensus diagnosis (defined as diagnostic agreement by at least 4 participating US GI pathologists).
There was substantial interobserver agreement among 4 pathologists from China on the interpretation of IBD-associated neoplasia (kappa value 0.68, 95% confidence interval: 0.56-0.78). A consensus diagnosis included negative ( = 22), LGD ( = 22), HGD ( = 3), carcinoma ( = 2), and indefinite for dysplasia ( = 1). Using consensus diagnoses as references, the agreement between each pathologist from China and the consensus diagnosis was substantial with kappa values ranging from 0.75 to 0.80.
This study reveals substantial interobserver agreement for the interpretation of colonic neoplasia in IBD using digitized images among Chinese pathologists as well as between each Chinese pathologist and a consensus diagnosis generated by US GI pathologists.
本研究旨在评估中国执业病理学家使用远程病理学诊断炎症性肠病（IBD）相关肿瘤形成的观察者间变异性，远程病理学是一种在国内和国际上越来越多地使用的远程诊断会诊方法，并将其与美国（US）亚专业胃肠（GI）病理学家的诊断结果进行比较。
来自美国的8名胃肠病理学家和4名对胃肠病理学感兴趣的中国病理学家参与了本研究。纳入了来自中国8个医疗中心的50例有IBD临床病史患者的结肠活检标本。使用Aperio系统对每个病例的所有显微镜载玻片进行数字化处理。一名病理学家（XL）查看数字化的全切片图像，并在低、中、高倍放大下以1712×1072像素的分辨率捕获感兴趣区域，并保存为只读DVD上的标记图像文件格式（TIFF）文件。每位病理学家评估图像，并为每个病例选择最合适的诊断类别（阴性、不确定、低级别异型增生[LGD]、高级别异型增生[HGD]和癌）。进行Fleiss' kappa系数（）分析以确定观察者间的一致性以及每位中国病理学家与共识诊断（定义为至少4名参与研究的美国胃肠病理学家的诊断一致）的一致性。
4名中国病理学家在IBD相关肿瘤形成的解读上存在高度观察者间一致性（kappa值为0.68，95%置信区间：0.56 - 0.78）。共识诊断包括阴性（ = 22）、LGD（ = 22）、HGD（ = 3）、癌（ = 2）和异型增生不确定（ = 1）。以共识诊断为参考，每位中国病理学家与共识诊断之间的一致性较高，kappa值范围为0.75至0.80。
本研究表明，中国病理学家之间以及每位中国病理学家与美国胃肠病理学家生成的共识诊断之间，在使用数字化图像解读IBD结肠肿瘤形成方面存在高度观察者间一致性。
