Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
Sci Rep. 2023 Aug 15;13(1):13260. doi: 10.1038/s41598-023-40221-6.
Interstitial fibrosis assessment by renal pathologists lacks good agreement, and we aimed to investigate its hidden properties and infer possible clinical impact. Fifty kidney biopsies were assessed by 9 renal pathologists and evaluated by intraclass correlation coefficients (ICCs) and kappa statistics. Probabilities of pathologists' assessments that would deviate far from true values were derived from quadratic regression and multilayer perceptron nonlinear regression. Likely causes of variation in interstitial fibrosis assessment were investigated. Possible misclassification rates were inferred on reported large cohorts. We found inter-rater reliabilities ranged from poor to good (ICCs 0.48 to 0.90), and pathologists' assessments had the worst agreements when the extent of interstitial fibrosis was moderate. 33.5% of pathologists' assessments were expected to deviate far from the true values. Variation in interstitial fibrosis assessment was found to be correlated with variation in interstitial inflammation assessment (r = 32.1%). Taking IgA nephropathy as an example, the Oxford T scores for interstitial fibrosis were expected to be misclassified in 21.9% of patients. This study demonstrated the complexity of the inter-rater reliability of interstitial fibrosis assessment, and our proposed approaches discovered previously unknown properties in pathologists' practice and inferred a possible clinical impact on patients.
肾病理学家评估间质纤维化的一致性较差，我们旨在研究其潜在特性并推断可能的临床影响。对 50 例肾活检标本进行了 9 位肾病理学家的评估，通过组内相关系数（ICC）和 Kappa 统计进行评估。通过二次回归和多层感知机非线性回归得出病理学家评估偏离真实值的概率。探讨了间质纤维化评估中可能存在的变异原因。推断了报告的大型队列中可能的分类错误率。我们发现组间可信度从低到高（ICC 0.48 至 0.90），当间质纤维化程度中等时，病理学家的评估一致性最差。预计 33.5%的病理学家评估结果将严重偏离真实值。间质纤维化评估的变异性与间质炎症评估的变异性相关（r=32.1%）。以 IgA 肾病为例，预计间质纤维化的牛津 T 评分将在 21.9%的患者中出现错误分类。本研究表明，间质纤维化评估的组间可靠性较为复杂，我们提出的方法发现了病理学家实践中以前未知的特性，并推断出对患者可能产生的临床影响。
