Marcussen N, Olsen S, Larsen S, Starklint H, Thomsen O F
University Institute of Pathology, Aarhus Kommunehospital, Denmark.
Clin Nephrol. 1995 Oct;44(4):220-4.
The inter-observer variation of the WHO classification of glomerulonephritis (GN) was studied using Kappa statistics. One hundred renal biopsies were selected with almost equal representation of the following types of GN: minimal change nephropathy, membranous GN, focal proliferative GN, diffuse mesangial proliferative GN, endocapillary GN, membranoproliferative GN, and crescentic GN. Slides stained with silver-methenamine and PAS-hematoxylin were circulated among the members of the panel, who made their diagnoses without knowing those of the other participants and without knowledge of the clinical conditions. There was a very good overall diagnostic agreement of 0.67 with a Kappa value of 0.61, figures which compete very well with other diagnostic systems analysed with Kappa statistics. Analysing the single types of GN, we found that the highest Kappa values were obtained for crescentic GN (0.81), endocapillary GN (0.79) and membranous GN (0.74) and the lowest Kappa values for membranoproliferative GN (0.40) and diffuse mesangial proliferative GN (0.44). Basically, the international classification of GN is founded upon light microscopy. Our results demonstrate that this system works generally well. The diagnostic reproducibility of the types with less satisfactory Kappa values can be expected to be improved by including immunopathology and electron microscopy.
使用Kappa统计量研究了肾小球肾炎（GN）的WHO分类在不同观察者之间的差异。选取了100例肾活检标本，以下几种类型的GN几乎各占相同比例：微小病变肾病、膜性GN、局灶增生性GN、弥漫性系膜增生性GN、毛细血管内增生性GN、膜增生性GN和新月体性GN。用六胺银和PAS苏木精染色的玻片在专家组成员之间传阅，他们在不知道其他参与者诊断结果以及临床情况的前提下做出自己的诊断。总体诊断一致性非常好，为0.67，Kappa值为0.61，这些数据与用Kappa统计量分析的其他诊断系统相比表现出色。分析单一类型的GN时，我们发现新月体性GN（0.81）、毛细血管内增生性GN（0.79）和膜性GN（0.74）的Kappa值最高，而膜增生性GN（0.40）和弥漫性系膜增生性GN（0.44）的Kappa值最低。基本上，GN的国际分类是基于光学显微镜检查的。我们的结果表明该系统总体上运行良好。通过纳入免疫病理学和电子显微镜检查，预计Kappa值不太理想的类型的诊断可重复性将得到提高。
