Skov B G, Broholm H, Engel U, Franzmann M B, Nielsen A L, Lauritzen A F, Skov T
Department of Pathology, Frederiksberg Hospital, Denmark.
Int J Gynecol Pathol. 1997 Jan;16(1):33-7. doi: 10.1097/00004347-199701000-00006.
In a blinded, randomized design, six histopathologists with an interest in gynecological pathology examined the inter- and intraobserver variation of the histopathological diagnosis of endometrial hyperplasia according to the World Health Organization (WHO) classification of 1975 and the new WHO classification of 1994. On four occasions, the pathologists assessed hematoxylin/eosin-stained slides from 128 cases originally diagnosed and coded in the Snomed system as endometrial hyperplasia. In the first and third rounds, the slides were classified according to the 1975 classification and in the second and fourth rounds according to the 1994 classification. The overall interobserver agreement in the two rounds where the 1975 classification was used was 0.47 and 0.51, and the kappa values 0.24 [95% confidence interval (CI) 0.21-0.27] and 0.30 (95% CI 0.27-0.33). The overall interobserver agreement in the two rounds using the 1994 classification was 0.45 and 0.41 and the kappa values 0.25 (95% CI 0.23-0.28) and 0.20 (95% CI 0.17-0.22). Reducing the classification to two categories with clinical significance (atypical endometrial hyperplasia versus others in the 1975 classification, and atypical endometrial hyperplasia, complex versus others in the 1994 classification) increased the overall agreement of the 1975 classification in both rounds to 0.91 and of the 1994 classification to 0.92 and 0.90. The kappa values increased to 0.54 (95% CI 0.49-0.58) and 0.49 (95% CI 0.45-0.54) in the 1975 classification and to 0.59 (95% CI 0.54-0.63) and 0.42 (95% CI 0.37-0.46) in the 1994 classification. The intraobserver overall agreement for the 1975 classification ranged from 0.80 to 0.55 and the kappa values from 0.70 (95% CI 0.58-0.81) to 0.28 (95% CI 0.17-0.39). The intraobserver overall agreement for the 1994 classification ranged from 0.71 to 0.46 and the kappa values from 0.60 (95% CI 0.51-0.70) to 0.20 (95% CI 0.09-0.30). It is concluded that there is considerable inter- and intraobserver variation using both the 1975 and the 1994 classifications of endometrial hyperplasia. We propose that there is need for a specification and for a simplification of the classification.
在一项双盲随机设计中，六位对妇科病理学感兴趣的组织病理学家，根据1975年世界卫生组织（WHO）分类标准和1994年WHO新分类标准，检查了子宫内膜增生组织病理学诊断的观察者间及观察者内差异。病理学家分四次评估了128例最初在Snomed系统中诊断并编码为子宫内膜增生的苏木精/伊红染色切片。在第一轮和第三轮中，切片根据1975年分类标准进行分类，在第二轮和第四轮中根据1994年分类标准进行分类。在使用1975年分类标准的两轮评估中，观察者间总体一致性分别为0.47和0.51，kappa值分别为0.24[95%置信区间（CI）0.21 - 0.27]和0.30（95%CI 0.27 - 0.33）。在使用1994年分类标准的两轮评估中，观察者间总体一致性分别为0.45和0.41，kappa值分别为0.25（95%CI 0.23 - 0.28）和0.20（95%CI 0.17 - 0.22）。将分类简化为具有临床意义的两类（1975年分类标准中的非典型子宫内膜增生与其他类型，以及1994年分类标准中的非典型子宫内膜增生、复杂性增生与其他类型）后，1975年分类标准在两轮评估中的总体一致性均提高到0.91，1994年分类标准在两轮评估中的总体一致性分别提高到0.92和0.90。1975年分类标准的kappa值分别提高到0.54（95%CI 0.49 - 0.58）和0.49（95%CI 0.45 - 0.54），1994年分类标准的kappa值分别提高到0.59（95%CI 0.54 - 0.63）和0.42（95%CI 0.37 - 0.46）。1975年分类标准的观察者内总体一致性范围为0.80至0.55，kappa值范围为0.70（95%CI 0.58 - 0.81）至0.28（95%CI 0.17 - 0.39）。1994年分类标准的观察者内总体一致性范围为0.71至0.46，kappa值范围为0.60（95%CI 0.51 - 0.70）至0.20（95%CI 0.09 - 0.30）。结论是，使用1975年和1994年子宫内膜增生分类标准时，观察者间及观察者内均存在相当大的差异。我们建议需要对分类进行规范和简化。
