Lock-Andersen J, Hou-Jensen K, Hansen J P, Jensen N K, Søgaard H, Andersen P K
Department of Plastic, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Scand J Plast Reconstr Surg Hand Surg. 1995 Jun;29(2):141-8. doi: 10.3109/02844319509034330.
To evaluate the variations within and between observers in the interpretation of important histological prognostic factors, a series of 96 melanoma patients was randomly selected from a database of 1691 patients with cutaneous malignant melanoma. The stained sections were examined on two occasions by four experienced pathologists. Analysis by observed agreement and kappa statistics showed maximal tumour thickness to be the best reproducible variable, with ulceration the second best. Regression was the least reproducible, with level of invasion and type of melanoma in the mid range. Intra-observer variation was uniformly less than inter-observer variation for each variable. For tumour thickness a variance component analysis was done to quantify the variability further. The clinician should not base his choice of treatment entirely on the microscopic classification but take into consideration the clinical course and appearance of the tumour.
为评估观察者在解读重要组织学预后因素时的内部及相互间差异，从1691例皮肤恶性黑色素瘤患者的数据库中随机选取了96例黑色素瘤患者。染色切片由四位经验丰富的病理学家分两次进行检查。通过观察一致性分析和kappa统计显示，最大肿瘤厚度是最具可重复性的变量，溃疡程度次之。回归分析的可重复性最差，浸润水平和黑色素瘤类型处于中等可重复性范围。每个变量的观察者内部差异均一致小于观察者间差异。对于肿瘤厚度，进行了方差成分分析以进一步量化变异性。临床医生不应完全基于显微镜分类来选择治疗方法，而应考虑肿瘤的临床病程和外观。
