Pavlisko Elizabeth N, Neely Megan L, Wikenheiser-Brokamp Kathryn A, Fishbein Gregory A, Litzky Leslie, Farver Carol F, Pal Prodipto, He Mai, Illei Peter B, Deshpande Charuhas, Robien Mark A, Kirchner Jerry, Frankel Courtney W, Lang Jason E, Belperio John A, Palmer Scott M, Sweet Stuart C
Department of Pathology, Duke University Medical Center, Durham, North Carolina.
Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
J Heart Lung Transplant. 2025 Feb;44(2):173-181. doi: 10.1016/j.healun.2024.10.007. Epub 2024 Oct 13.
Poor agreement among lung transplant (LTx) pathologists has been reported in the assessment of rejection. In addition to acute rejection (AR) and lymphocytic bronchiolitis (LB), acute lung injury (ALI) and organizing pneumonia (OP) were recently identified as histopathologic risk factors for chronic lung allograft dysfunction (CLAD). Therefore, maximizing inter-rater reliability (IRR) for identifying these histopathologic risk factors is important to guide individual patient care and to support incorporating them in inclusion criteria for clinical trials in lung transplantation.
Nine pathologists across 8 North American LTx centers were surveyed for practices in the assessment of LTx transbronchial biopsies. We conducted 7 diagnostic alignment sessions with pathologists discussing histomorphologic features of CLAD high-risk histopathology. Then, each pathologist blindly scored 75 digitized slides. Fleiss' kappa, accounting for agreement across numerous observers, was used to determine IRR across all raters for the presence of any high-risk finding and each individual entity.
IRR (95% confidence intervals) and % agreement for any high-risk finding (AR, LB, ALI, and/or OP) and each individual finding is as follows: Any Finding, k = 0.578 (0.487, 0.668), 78.9%; AR, k = 0.582 (0.481, 0.651), 79.1%; LB, k = 0.683 (0.585, 0.764), 83.5%; ALI, k = 0.418 (0.312, 0.494), 70.9%; and OP, k = 0.621 (0.560, 0.714), 81.0%.
After prestudy diagnostic alignment sessions, a multicenter group of LTx pathologists seeking to identify histopathology high-risk for CLAD achieved good IRR.
据报道，肺移植（LTx）病理学家在排斥反应评估方面的一致性较差。除急性排斥反应（AR）和淋巴细胞性细支气管炎（LB）外，急性肺损伤（ALI）和机化性肺炎（OP）最近被确定为慢性肺移植功能障碍（CLAD）的组织病理学危险因素。因此，提高识别这些组织病理学危险因素的评分者间可靠性（IRR）对于指导个体患者护理以及支持将其纳入肺移植临床试验的纳入标准非常重要。
对北美8个LTx中心的9名病理学家进行了调查，了解他们在评估LTx经支气管活检方面的做法。我们与病理学家进行了7次诊断一致性会议，讨论CLAD高危组织病理学的组织形态学特征。然后，每位病理学家对75张数字化切片进行盲法评分。使用Fleiss' kappa（考虑众多观察者之间的一致性）来确定所有评分者对任何高危发现和每个个体实体存在情况的IRR。
任何高危发现（AR、LB、ALI和/或OP）以及每个个体发现的IRR（95%置信区间）和一致率如下：任何发现，κ = 0.578（0.487，0.668），78.9%；AR，κ = 0.582（0.481，0.651），79.1%；LB，κ = 0.683（0.585，0.764），83.5%；ALI，κ = 0.418（0.312，0.494），70.9%；OP，κ = 0.621（0.560，0.714），81.0%。
经过研究前的诊断一致性会议后，一组多中心的LTx病理学家在识别CLAD的组织病理学高危情况方面达到了良好的IRR。
