Silverberg S G
Hum Pathol. 1976 Jul;7(4):451-4. doi: 10.1016/s0046-8177(76)80058-5.
In order to ascertain the reproducibility of the mitosis count in histologic tumor diagnosis, a reference set of 10 microscopic slides from smooth muscle tumors of the uterus was shown to six different pathologists, who were asked to record the number of mitotic figures per 10 high power fields in the most active region of each slide. The results, when tubulated, revealed considerable observer variation in this supposedly objective and quantitative diagnostic criterion. The diagnosis of benignity or malignancy, based on this criterion alone, were unamimous in only four of the 10 cases, whereas the diagnoses based on a constellation of histologic criteria were unanimous in all cases and correlated well with the subsequent clinical evolution of those cases with follow-up data. Possible reasons for the lack of reproducibility of the mitosis count are discussed. We conclude that a qualitative estimation of mitotic activity is helpful as one of the diagnostic and prognostic criteria in the assessment of uterine and other smooth muscle tumors, but that it cannot be used as the sole criterion for distinguishing benign from malignant tumors.
为了确定组织学肿瘤诊断中有丝分裂计数的可重复性，向六位不同的病理学家展示了一组来自子宫平滑肌瘤的10张显微切片，并要求他们记录每张切片最活跃区域每10个高倍视野中的有丝分裂象数量。将结果制成表格后发现，在这个本应客观且定量的诊断标准方面，观察者之间存在相当大的差异。仅基于这一标准做出的良性或恶性诊断，在10例病例中只有4例是一致的，而基于一系列组织学标准做出的诊断在所有病例中都是一致的，并且与那些有随访数据的病例随后的临床病程密切相关。文中讨论了有丝分裂计数缺乏可重复性的可能原因。我们得出结论，有丝分裂活性的定性评估作为评估子宫及其他平滑肌瘤的诊断和预后标准之一是有帮助的，但它不能用作区分良性肿瘤和恶性肿瘤的唯一标准。
