Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut.
Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut.
Clin Transplant. 2018 Dec;32(12):e13441. doi: 10.1111/ctr.13441. Epub 2018 Dec 6.
Prior studies demonstrate poor agreement among pathologists' interpretation of kidney biopsy slides. Reliability of representative images of these slides uploaded to the United Network of Organ Sharing (UNOS) web portal for clinician review has not been studied. We hypothesized high agreement among pathologists' image interpretation, since static images eliminate variation induced by viewing different areas of movable slides. To test our hypothesis, we compared the assessments of UNOS-uploaded images recorded in standardized forms by three pathologists. We selected 100 image sets, each having at least two images from kidneys of deceased donors. Weighted Cohen's kappa was used for inter-rater agreement. Mean (SD) donor age was 50 (13). Acute tubular injury had kappas of 0.12, 0.14, and 0.19; arteriolar hyalinosis 0.16, 0.27, and 0.38; interstitial inflammation 0.30, 0.33, and 0.49; interstitial fibrosis 0.28, 0.32, and 0.67; arterial intimal fibrosis 0.34, 0.42, and 0.59; tubular atrophy 0.35, 0.41, and 0.52; glomeruli thrombi 0.32, 0.53, and 0.85; and global glomerulosclerosis 0.68, 0.70, and 0.77. Pathologists' agreement demonstrated kappas of 0.12 to 0.77. The lower values raise concern about the reliability of using images. Although further research is needed to understand how uploaded images are used clinically, the field may consider higher-quality standards for biopsy photomicrographs.
先前的研究表明，病理学家对肾脏活检切片的解释存在较差的一致性。尚未研究这些切片的代表性图像上传到联合器官共享网络 (UNOS) 门户网站以供临床医生审查的可靠性。我们假设病理学家的图像解释具有高度一致性，因为静态图像消除了由于查看可移动切片的不同区域而引起的变化。为了检验我们的假设，我们比较了三位病理学家在标准化表格中记录的 UNOS 上传图像的评估结果。我们选择了 100 个图像集，每个图像集至少有两个来自已故供体肾脏的图像。使用加权 Cohen's kappa 评估评分者间的一致性。平均（SD）供体年龄为 50（13）岁。急性肾小管损伤的 kappa 值为 0.12、0.14 和 0.19；小动脉玻璃样变性为 0.16、0.27 和 0.38；间质炎症为 0.30、0.33 和 0.49；间质纤维化为 0.28、0.32 和 0.67；动脉内膜纤维化为 0.34、0.42 和 0.59；肾小管萎缩为 0.35、0.41 和 0.52；肾小球血栓形成 0.32、0.53 和 0.85；以及全球肾小球硬化为 0.68、0.70 和 0.77。病理学家的一致性显示 kappa 值为 0.12 至 0.77。较低的值引起了对使用图像的可靠性的担忧。尽管需要进一步研究以了解如何在临床上使用上传的图像，但该领域可能会考虑为活检照片制定更高质量的标准。
