Department of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 85259, USA.
BMC Pulm Med. 2021 Jun 1;21(1):184. doi: 10.1186/s12890-021-01522-6.
Current interstitial lung disease (ILD) diagnostic guidelines assess criteria across clinical, radiologic and pathologic domains. Significant interobserver variation in histopathologic evaluation has previously been shown but the specific source of these discrepancies is poorly documented. We sought to document specific areas of difficulty and develop improved criteria that would reduce overall interobserver variation.
Using an internet-based approach, we reviewed selected images of specific diagnostic features of ILD histopathology and whole slide images of fibrotic ILD. After an initial round of review, we confirmed the presence of interobserver variation among our group. We then developed refined criteria and reviewed a second set of cases.
The initial round reproduced the existing literature on interobserver variation in diagnosis of ILD. Cases which were pre-selected as inconsistent with usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) were confirmed as such by multi-observer review. Cases which were thought to be in the spectrum of chronic fibrotic ILD for which UIP/IPF were in the differential showed marked variation in nearly all aspects of ILD evaluation including extent of inflammation and extent and pattern of fibrosis. A proposed set of more explicit criteria had only modest effects on this outcome. While we were only modestly successful in reducing interobserver variation, we did identify specific reasons that current histopathologic criteria of fibrotic ILD are not well defined in practice.
Any additional classification scheme must address interobserver variation in histopathologic diagnosis of fibrotic ILD order to remain clinically relevant. Improvements to tissue-based diagnostics may require substantial resources such as larger datasets or novel technologies to improve reproducibility. Benchmarks should be established for expected outcomes among clinically defined subgroups as a quality metric.
目前的间质性肺疾病（ILD）诊断指南评估了临床、放射和病理领域的标准。先前已经证明了组织病理学评估存在显著的观察者间差异，但这些差异的具体来源记录不佳。我们旨在记录具体的困难领域，并制定可减少整体观察者间差异的改进标准。
我们使用基于互联网的方法，回顾了ILD 组织病理学特定诊断特征的选定图像和纤维化 ILD 的全切片图像。在第一轮审查后，我们确认了我们小组之间存在观察者间差异。然后，我们制定了更精细的标准并审查了第二组病例。
第一轮再现了关于 ILD 诊断中观察者间差异的现有文献。被预先选择为不符合特发性间质性肺炎/特发性肺纤维化（UIP/IPF）的病例通过多观察者审查被确认为如此。被认为在慢性纤维化 ILD 谱中且 UIP/IPF 是鉴别诊断的病例在几乎所有 ILD 评估方面都存在明显差异，包括炎症程度和纤维化程度和模式。一套更明确的标准建议对这一结果仅有适度影响。虽然我们在减少观察者间差异方面仅取得适度成功，但我们确实确定了当前纤维化 ILD 的组织病理学标准在实践中未得到很好定义的具体原因。
任何额外的分类方案都必须解决纤维化 ILD 组织病理学诊断中的观察者间差异，才能保持临床相关性。改善基于组织的诊断可能需要大量资源，例如更大的数据集或新技术，以提高可重复性。应根据临床定义的亚组建立预期结果的基准作为质量指标。
