Botega Amanda Araujo Dos Reis, Amorim Carolina Viza, Teixeira Fernanda, Borges Figueira de Mello Cristina Diniz, Stelini Rafael Fantelli, Velho Paulo Eduardo Neves Ferreira, Cintra Maria Leticia
Department of Pathology, School of Medical Sciences, State University of Campinas, Campinas, Brazil.
Department of Dermatology, School of Medical Sciences, State University of Campinas, Campinas, Brazil.
Skin Appendage Disord. 2023 Jan;9(1):34-41. doi: 10.1159/000526966. Epub 2022 Nov 25.
Distinguishing scarring (SA) versus non-scarring alopecia (NSA) may not be a simple procedure on either clinical or histopathological views.
We sought to study the interobserver variability in the histopathological assessment of SA versus NSA, including clinical-pathological considerations.
Two dermatopathologists independently interpreted the same set of 100 specimens (89 patients). The samples were serial sectioned and stained by hematoxylin and eosin and Verhöeff methods. The patients' mean age was 46 years, with 13 being males and 76 females.
In 16/100 samples, there was no consensus among the two examiners regarding SA versus NSA (weighted kappa = 0.6583; 95% CI); 3/16 patients were re-biopsied, and in the second sample, consensus was reached. In 76/89 patients, the anatomopathological examination was helpful in defining the SA versus NSA subtype. Of the 84 samples in which there was interobserver agreement, 4 which had been considered scarring in the routine pathological report were re-classified as non-scarring, whereas one biopsy, previously diagnosed as non-scarring, was now considered cicatricial due to the newly found areas of lichenoid inflammation in the infundibular epithelium.
The ideal scalp examination may require deep serial biopsy sectioning, elastic tissue stain, re-biopsy, and strict clinical-evolutive correlation.
从临床或组织病理学角度来看，区分瘢痕性脱发（SA）和非瘢痕性脱发（NSA）并非易事。
我们试图研究在SA与NSA的组织病理学评估中观察者间的变异性，包括临床病理因素。
两位皮肤病理学家独立解读同一组100份标本（89例患者）。样本进行连续切片，并用苏木精和伊红以及韦尔霍夫方法染色。患者的平均年龄为46岁，其中男性13例，女性76例。
在100份样本中的16份中，两位检查者在SA与NSA的判断上未达成共识（加权kappa = 0.6583；95%置信区间）；16例患者中有3例重新进行了活检，在第二次样本中达成了共识。在89例患者中的76例中，解剖病理学检查有助于确定SA与NSA的亚型。在观察者间达成一致的84份样本中，有4份在常规病理报告中被认为是瘢痕性的，现重新分类为非瘢痕性，而1份活检样本之前被诊断为非瘢痕性，由于在漏斗状上皮中新发现苔藓样炎症区域，现在被认为是瘢痕性的。
理想的头皮检查可能需要进行深部连续活检切片、弹性组织染色、重新活检以及严格的临床演变相关性分析。
