Department of Medicine, Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, Alberta, Canada.
Medical University of Warsaw, Warsaw, Poland.
Am J Transplant. 2020 May;20(5):1341-1350. doi: 10.1111/ajt.15752. Epub 2020 Jan 23.
Discrepancy analysis comparing two diagnostic platforms offers potential insights into both without assuming either is always correct. Having optimized the Molecular Microscope Diagnostic System (MMDx) in renal transplant biopsies, we studied discrepancies within MMDx (reports and sign-out comments) and between MMDx and histology. Interpathologist discrepancies have been documented previously and were not assessed. Discrepancy cases were classified as "clear" (eg, antibody-mediated rejection [ABMR] vs T cell-mediated rejection [TCMR]), "boundary" (eg, ABMR vs possible ABMR), or "mixed" (eg, Mixed vs ABMR). MMDx report scores showed 99% correlations; sign-out interpretations showed 7% variation between observers, all located around boundaries. Histology disagreed with MMDx in 37% of biopsies, including 315 clear discrepancies, all with implications for therapy. Discrepancies were distributed widely in all histology diagnoses but increased in some scenarios; for example, histology TCMR contained 14% MMDx ABMR and 20% MMDx no rejection. MMDx usually gave unambiguous diagnoses in cases with ambiguous histology, for example, borderline and transplant glomerulopathy. Histology lesions or features associated with more frequent discrepancies (eg, tubulitis, arteritis, and polyomavirus nephropathy) were not associated with increased MMDx uncertainty, indicating that MMDx can clarify biopsies with histologic ambiguity. The patterns of histology-MMDx discrepancies highlight specific histology diagnoses in which MMDx assessment should be considered for guiding therapy.
比较两种诊断平台的差异分析可以提供对两者的潜在见解，而无需假设其中任何一种总是正确的。在对肾脏移植活检进行了 Molecular Microscope Diagnostic System (MMDx) 的优化后，我们研究了 MMDx 内部（报告和签字评论）和 MMDx 与组织学之间的差异。以前已经记录了病理学家之间的差异，但未进行评估。差异病例被分类为“明确”（例如，抗体介导的排斥反应[ABMR]与 T 细胞介导的排斥反应[TCMR]）、“边界”（例如，ABMR 与可能的 ABMR）或“混合”（例如，混合与 ABMR）。MMDx 报告评分显示 99%的相关性；签字解读显示观察者之间有 7%的差异，所有差异都位于边界附近。组织学与 MMDx 在 37%的活检中存在分歧，包括 315 个明确的差异，所有这些差异都对治疗有影响。差异在所有组织学诊断中广泛分布，但在某些情况下会增加；例如，组织学 TCMR 包含 14%的 MMDx ABMR 和 20%的 MMDx 无排斥反应。MMDx 通常在组织学存在模糊的情况下给出明确的诊断，例如边缘性和移植肾小球病。与更频繁差异相关的组织学病变或特征（例如，小管炎、动脉炎和多瘤病毒肾病）与 MMDx 的不确定性增加无关，这表明 MMDx 可以澄清组织学存在模糊性的活检。组织学与 MMDx 差异的模式突出了某些组织学诊断，应考虑 MMDx 评估以指导治疗。
