Bioregulation Department, Health and Science Institute, Federal University of Bahia, Salvador, Brazil.
Postgraduate Program in Medicine and Health, Medical School of Medicine, Federal University of Bahia, Salvador, Brazil.
Endocrine. 2022 Sep;77(3):486-492. doi: 10.1007/s12020-022-03104-w. Epub 2022 Jun 9.
The subjective evaluation of nuclear features in follicular-patterned lesions of the thyroid is a reason for diagnosis discordance. The assessment of nuclear features also varies whether the observation is performed optically or digitally. Our objective was to study the concordance among pathologists regarding the nuclear score (NS) evaluation in a series of follicular-patterned lesions, using optical versus three digital scanning protocols.
Three pathologists evaluated the NS in a 3mm area randomly selected from 20 hematoxylin-eosin slides representative of the respective 20 follicular-patterned thyroid lesions. The NS evaluation was performed using optical and three different scanning protocols in two scanners: P1000_20x, P1000_40x and DP200_20x. Kappa statistic (κ) and intraclass correlation coefficient (ICC) were obtained for intra- and interpathologist concordance.
We recorded a good agreement among pathologists in the optical evaluation of the NS (ICC of 0.73). The concordance between optical versus digital observation had an almost perfect agreement for P1000_20x [κ = 0.85 (0.67-1.02); p < 0.0001] and a substantial agreement for both P1000_40x [κ = 0.69 (0.43-0.95) p = 0.002] and DP200_20x [κ = 0.77 (0.57-0.97); p = 0.001]. The P1000_20x protocol had the best intrapathologist concordance with the optical method, classified as almost perfect agreement for pathologists A (80%) and B (85%), and substantial agreement for pathologist C (70%).
Digital observation of the WSI is valid for the NS evaluation in follicular-patterned thyroid lesions, with good agreement among pathologists and between optical and scanning protocols. Performance studies and validation procedures cannot be avoided in this setting to prevent diagnostic discordance due to the scanning process.
甲状腺滤泡模式病变中核特征的主观评估是导致诊断不一致的原因之一。光学或数字观察时，对核特征的评估也存在差异。我们的目的是研究在一系列滤泡模式病变中，使用光学和三种不同的数字扫描方案评估核评分（NS）时病理学家之间的一致性。
三位病理学家在代表各自 20 个滤泡模式甲状腺病变的 20 个苏木精-伊红切片中随机选择 3mm 区域，评估 NS。使用光学和两种扫描仪的三种不同扫描方案（P1000_20x、P1000_40x 和 DP200_20x）评估 NS。获取组内和组间病理学家一致性的kappa 统计量（κ）和组内相关系数（ICC）。
在光学 NS 评估中，病理学家之间具有良好的一致性（ICC 为 0.73）。光学与数字观察之间的一致性对于 P1000_20x 具有近乎完美的一致性（κ=0.85（0.67-1.02）；p<0.0001），对于 P1000_40x 和 DP200_20x 具有高度一致的一致性（κ=0.69（0.43-0.95）p=0.002；κ=0.77（0.57-0.97）；p=0.001）。P1000_20x 方案与光学方法具有最佳的组内病理学家一致性，病理学家 A（80%）和 B（85%）的分类为近乎完美一致，病理学家 C（70%）的分类为高度一致。
数字观察 WSI 可用于评估滤泡模式甲状腺病变中的 NS，病理学家之间以及光学和扫描方案之间具有良好的一致性。在这种情况下，不能避免性能研究和验证程序，以防止由于扫描过程导致的诊断不一致。
