Has the 2004 revision of the International Society of Heart and Lung Transplantation grading system improved the reproducibility of the diagnosis and grading of cardiac transplant rejection?

A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: The European experience

“…The kappa value increased from 0.31 to 0.39 for the 1990 and 2004 classifica- Although slightly disappointing these results are in keeping with the results obtained by the UCLA group in their reproducibility study in which they evaluated inter-and intraobserver reproducibility in a group of pathologists from the same center using glass slides. 13 Reproducibility of grading systems is usually tested within small groups of pathologists who have previously worked or trained together 13 and thus should be more similar than individuals who have never worked together. Our study represents the first attempt, at the European level, to assess reproducibility of the ISHLT 2004 grading scheme among pathologists at different transplant centers and with varied experience.…”

SaLUTaRy: Survey of lung transplant rejection

“…26 Similar findings of significant interobserver variability, despite a revised grading system, were also reported for interpretation of cardiac allograft biopsy specimens. 27 Finally, we found disagreement among pathologists regarding ordering of routine special stains for lung transplant biopsy specimens. Although the guidelines recommend a trichrome stain, less than 50% of the pathologists surveyed in our study order one, and it may not substantially add to the diagnosis.…”

Next-generation endomyocardial biopsy: the potential of confocal and super-resolution microscopy

“…Unfortunately, a subsequent study showed no improvement in reproducibility between pathologists. The reasons for disagreement were found to be the subjectivity involved in assessing: (1) the degree of inflammatory infiltrate and (2) the degree of myocyte injury [31]. These areas could benefit from development of quantitative image processing tools to help define the boundaries between rejection grades.…”

“…This poor contrast makes it difficult and time-consuming to quantify pathological features, causing assessments to rely on the subjective categorisation by the pathologist. Although evaluation is made by experienced personnel, considerable inter-operator variability is often observed [31].…”