Dere Yelda, Çelik Özgür Ilhan, Çelik Serkan Yasar, Ekmekçi Sümeyye, Evcim Gözde, Pehlivan Fatma, Ağalar Anıl, Deliktaş Hasan, Çulhacı Nil
Department of Pathology, Faculty of Medicine, Mugla Sitki Kocman University, Izmir, Turkey.
Department of Pathology, Tepecik Training and Research Hospital, Izmir, Turkey.
Indian J Pathol Microbiol. 2020 Feb;63(Supplement):S25-S29. doi: 10.4103/IJPM.IJPM_288_18.
Gleason scoring is the grading system which strongly predicts the prognosis of prostate cancer. However, even being one of the most commonly used systems, the presence of different interobserver agreement rates push the uropathologists update the definitons of the Gleason patterns. In this study, we aimed to determine the interobserver agreement variability among 7 general pathologists, and one expert uropathologist from 6 different centers.
A set of 50 Hematoxylin & Eosin stained slides from 41 patients diagnosed as prostate cancer were revised by 8 different pathologists. The pathologists were also grouped according to having their residency at the same institute or working at the same center. All pathologists' and the subgroups' Gleason scores were then compared for interobserver variability by Fleiss' and Cohen's kappa tests using R v3.2.4.
There were about 8 pathologists from 6 different centers revised all the slides. One of them was an expert uropathologist with experience of 18 years. Among 7 general pathologists 4 had surgical pathology experience for over 5 years whilst 3 had under 5 years. The Fleiss' kappa was found as 0.54 for primary Gleason pattern, and 0.44 for total Gleason score (moderate agreement). The Fleiss' kappa was 0.45 for grade grouping system.
Assigning a Gleason score for a patient can be problematic because of different interobserver agreement rates among pathologists even though the patterns were accepted as well-defined.
Gleason评分是一种能有力预测前列腺癌预后的分级系统。然而，即便作为最常用的系统之一，不同观察者间一致率的存在促使泌尿病理学家更新Gleason模式的定义。在本研究中，我们旨在确定7名普通病理学家和1名来自6个不同中心的泌尿病理专家之间观察者间的一致性差异。
8名不同的病理学家对一组来自41例诊断为前列腺癌患者的50张苏木精和伊红染色切片进行了复查。病理学家还根据是否在同一机构接受住院医师培训或在同一中心工作进行了分组。然后，使用R v3.2.4通过Fleiss和Cohen卡方检验比较所有病理学家及其亚组的Gleason评分，以评估观察者间的差异。
来自6个不同中心的约8名病理学家复查了所有切片。其中一名是有18年经验的泌尿病理专家。在7名普通病理学家中，4名有超过5年的外科病理经验，而3名不足5年。原发性Gleason模式的Fleiss卡方值为0.54，总Gleason评分为0.44（中等一致性）。分级分组系统的Fleiss卡方值为0.45。
尽管Gleason模式被认为是明确的，但由于病理学家之间观察者间一致率不同，为患者指定Gleason评分可能存在问题。
