Howat A J, Beck S, Fox H, Harris S C, Hill A S, Nicholson C M, Williams R A
Department of Histopathology, Royal Preston Hospital.
J Clin Pathol. 1993 Jul;46(7):599-602. doi: 10.1136/jcp.46.7.599.
To assess the degree of difficulty in diagnosing partial mole by analysing intraobserver and interobserver agreement among a group of pathologists for these diagnoses.
Fifty mixed cases of partial mole, complete mole, and non-molar pregnancy were submitted to seven histopathologists, two of whom are expert gynaecological pathologists; the other five were district general hospital consultants, one of whom works in Australia. These participants gave each slide a firm diagnosis of either partial mole, complete mole, or non-molar pregnancy. Some 12 months later, the slides were recorded and again submitted for a second diagnostic round to assess intraobserver as well as interobserver agreement. Standard histological criteria for each diagnostic category were circulated with the slides.
kappa statistics showed that complete mole could be reliably distinguished from non-molar pregnancy, but neither non-molar pregnancy nor complete mole could be easily differentiated from partial mole. In only 35 out of 50 cases was there agreement between five or more of the seven participants. Agreement between the expert gynaecological pathologists was no better than for others in the group. Interestingly, the intraobserver agreement for each pathologist was good to excellent.
These results imply that the reported histological criteria are either not being applied consistently or that they are lacking in practical use. An atypical growth pattern of trophoblast, rather than the polar accentuation seen in normal first trimester pregnancies, seems to be the important diagnostic histological feature for partial mole. Ploidy studies might also help with problem cases.
通过分析一组病理学家对部分性葡萄胎诊断的观察者内和观察者间一致性，评估诊断部分性葡萄胎的难度。
向七位组织病理学家提交了五十例部分性葡萄胎、完全性葡萄胎和非葡萄胎妊娠的混合病例，其中两位是妇科病理专家，另外五位是地区综合医院的会诊医生，其中一位在澳大利亚工作。这些参与者对每张切片做出明确诊断，即部分性葡萄胎、完全性葡萄胎或非葡萄胎妊娠。大约十二个月后，对切片进行记录并再次提交进行第二轮诊断，以评估观察者内和观察者间的一致性。每个诊断类别的标准组织学标准随切片一同分发。
kappa统计显示，完全性葡萄胎可与非葡萄胎妊娠可靠区分，但非葡萄胎妊娠和完全性葡萄胎均不易与部分性葡萄胎区分。在五十例病例中，只有三十五例七位参与者中有五人或更多人意见一致。妇科病理专家之间的一致性并不比该组其他人员更好。有趣的是，每位病理学家的观察者内一致性良好至优秀。
这些结果表明，所报告的组织学标准要么未得到一致应用，要么缺乏实际用途。滋养细胞的非典型生长模式，而非正常孕早期妊娠所见的极性增强，似乎是部分性葡萄胎重要的诊断组织学特征。倍体研究可能也有助于解决疑难病例。
