Interobserver variation in the reporting of cervical colposcopic biopsy specimens: comparison of grading systems.

McCluggage, W. Glenn; Bharucha, H.; Caughley, L. M.; Date, Anand; Hamilton, Peter; Thornton, Claire M.; Walsh, Maureen

doi:10.1136/jcp.49.10.833

Cited by 102 publications

(63 citation statements)

References 8 publications

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“…We show moderate interobserver diagnostic reproducibility by a mixed group of 19 pathologists evaluating HPV related lesions of the cervix. Our results are in accordance with previously reported CIN diagnosis inter-observer reproducibility's ranging from poor to good (kappa 0.23-0.64) (2,3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and likewise CIN 2 has the lowest interobserver diagnostic reproducibility (1-4, 7-11, 13-15, 21-23). Some pathologists who report results in the CIN system have reduced used of the CIN2 diagnostic category to such a low frequency that in their hands it becomes a de facto 2-class system.…”

Section: Interobserver Reproducibility Of Patient Management Among Gysupporting

confidence: 82%

Diagnostic and treatment reproducibility of cervical intraepithelial neoplasia / squamous intraepithelial lesion and factors affecting the diagnosis

Saglam

Usubütün²,

Dolgun³

et al. 2017

TJPATH

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IntRODUCtIOnDiagnosis and management of Human Papilloma Virus (HPV)-related cervical lesions is a struggle. The main problem is which patient to treat, a decision largely (not solely) based on pathological diagnosis. Diagnosis is nontrivial due to conflicting classification schemas [3-class cervical intraepithelial neoplasia (CIN) vs. 2-class squamous intraepithelial lesion (SIL)] and subjective diagnostic criteria that are variously interpreted amongst pathologists (1-3). A recent study by Gage et al. showed that women would have a different probability of being treated depending on which laboratory and hence which pathologists reviewed the biopsy specimen (4).The aim of this study was to assess the interobserver reproducibility of the two classification systems of HPVrelated lesions of the cervix, namely the three-tiered "CIN" AbstRACtObjective: Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of "cervical intraepithelial neoplasia" (CIN) and "squamous intraepithelial lesion" (SIL) diagnoses. Material and Method:19 pathologists evaluated 66 cases once using H&E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. Results:We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry.We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic "styles" and gynecologists had management "styles". Conclusion:In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.

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Section: Interobserver Reproducibility Of Patient Management Among Gysupporting

confidence: 82%

Diagnostic and treatment reproducibility of cervical intraepithelial neoplasia / squamous intraepithelial lesion and factors affecting the diagnosis

Saglam

Usubütün²,

Dolgun³

et al. 2017

TJPATH

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“…37 A value Ͼ0.75 indicates excellent agreement, 0.4 to 0.75 indicates fair to good agreement, and Ͻ0.4 indicates poor agreement. 38 …”

Section: Item Reliabilitymentioning

confidence: 99%

Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients

Mao

Hsueh

Tang

et al. 2002

Stroke

377

229

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Background and Purpose-This study compared the psychometric properties of 3 clinical balance measures, the Berg Balance Scale (BBS), the Balance subscale of the Fugl-Meyer test (FM-B), and the Postural Assessment Scale for Stroke Patients (PASS), in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset. Methods-One hundred twenty-three stroke patients were followed up prospectively with the 3 balance measures 14, 30, 90, and 180 days after stroke onset (DAS). Reliability (interrater reliability and internal consistency) and validity (concurrent validity, convergent validity, and predictive validity) of each measure were examined. A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity. Results-The FM-B and BBS showed a significant floor or ceiling effect at some DAS points, whereas the PASS did not show these effects. The BBS, FM-B, and PASS all had good reliability and validity for patients at different recovery stages after stroke. The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but, as expected, only a low level of responsiveness at 90 to 180 DAS. The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset, 14 to 30 DAS. Conclusions-All 3 measures tested showed very acceptable levels of reliability, validity, and responsiveness for both clinicians and researchers. The PASS showed slightly better psychometric characteristics than the other 2 measures.

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“…As expected, classification agreement with lower variability between observers can be improved in a 2-tiered versus a 3-tiered system [10,28,[78][79][80][81][82][83][84][85][86][87]. Improved agreement among pathologists leads to a more consistent and reproducible diagnosis, which may lead to more valid clinical outcome data.…”

Section: Wg2 Recommendation Nomentioning

confidence: 99%

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

Darragh

Colgan

Cox

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

630

372

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The terminology for human papillomavirus (HPV)–associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care.

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Interobserver variation in the reporting of cervical colposcopic biopsy specimens: comparison of grading systems.

Cited by 102 publications

References 8 publications

Diagnostic and treatment reproducibility of cervical intraepithelial neoplasia / squamous intraepithelial lesion and factors affecting the diagnosis

Diagnostic and treatment reproducibility of cervical intraepithelial neoplasia / squamous intraepithelial lesion and factors affecting the diagnosis

Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

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