Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic

Svanholm, Hans; Starklint, H; Gundersen, H.J.G.; Fabricius, J; Barlebo, H.; Olsen, Steen

doi:10.1111/j.1699-0463.1989.tb00464.x

Cited by 411 publications

(229 citation statements)

References 16 publications

(3 reference statements)

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“…The present evaluation documented a substantial intraobserver reproducibility, κ = 0.62, and a moderate interobserver reproducibility, κ = 0.59, representing an acceptable reproducibility (Landis and Koch, 1977;Svanholm et al, 1989). Other workers have previously reported substantial intraobserver reproducibility, κ = 0.66, by using only two grades (Fox et al, 1997).…”

Section: Reproducibility Of Vascular Gradingsupporting

confidence: 72%

Vascular grading of angiogenesis: prognostic significance in breast cancer

et al. 2000

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SummaryThe study aimed to evaluate the prognostic value of angiogenesis by vascular grading of primary breast tumours, and to evaluate the prognostic impact of adding the vascular grade to the Nottingham Prognostic Index (NPI). The investigation included 836 patients. The median follow-up time was 11 years and 4 months. The microvessels were immunohistochemically stained by antibodies against CD34. Angiogenesis was graded semiquantitatively by subjective scoring into three groups according to the expected number of microvessels in the most vascular tumour area. The vascular grading between observers was moderately reproduced (κ = 0.59). Vascular grade was significantly associated with axillary node involvement, tumour size, malignancy grade, oestrogen receptor status and histological type. In univariate analyses vascular grade significantly predicted recurrence free survival and overall survival for all patients (P < 0.0001), node-negative patients (P < 0.0001) and node-positive patients (P < 0.0001). Cox multivariate regression analysis showed that vascular grading contributed with independent prognostic value in all patients (P < 0.0001). A prognostic index including the vascular grade had clinical impact for 24% of the patients, who had a shift in prognostic group, as compared to NPI, and implied a better prognostic dissemination. We concluded that the angiogenesis determined by vascular grading has independent prognostic value of clinical relevance for patients with breast cancer.

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Section: Reproducibility Of Vascular Gradingsupporting

confidence: 72%

Vascular grading of angiogenesis: prognostic significance in breast cancer

et al. 2000

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“…Interobserver agreement between readers 1 and 2 was assessed by a weighted -test. The -values were considered slight for Յ 0.2, fair for ϭ 0.21-0.4, moderate for ϭ 0.41-0.6, substantial for ϭ 0.61-0.8, and almost perfect for ϭ 0.81-1.00 (21). In addition, agreement between both readers was assessed using the Spearman correlation coefficient.…”

Section: Resultsmentioning

confidence: 99%

Quantification of renal perfusion abnormalities using an intravascular contrast agent (part 2): Results in animals and humans with renal artery stenosis

Schoenberg

Aumann

Just

et al. 2003

Magnetic Resonance in Med

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The interrelation between the morphologic degree of renal artery stenosis and changes in parenchymal perfusion is assessed using an intravascular contrast agent. In seven adult foxhounds, different degrees of renal artery stenosis were created with an inflatable clamp implanted around the renal artery. Dynamic susceptibility-weighted gradient-echo imaging was used to measure signal-time curves in the renal artery and the renal parenchyma during administration of 1.5 mg/kg BW of an intravascular ultrasmall particle iron oxide (USPIO) contrast agent. From the dynamic series, regional renal blood volume (rRBV), regional renal blood flow (rRBF), and mean transit time (MTT) were calculated. The morphologic degree of stenosis was measured in the steady state using a high-resolution 3D contrast-enhanced (CE) MR angiography (MRA) sequence (voxel size ‫؍‬ 0.7 ؋ 0.7 ؋ 1 mm 3 ). Five patients with renoparenchymal damage due to long-standing renal artery stenosis were evaluated. In the animal stenosis model, cortical perfusion remained unchanged for degrees of renal artery stenosis up to 80%. With degrees of stenoses > 80%, cortical perfusion dropped to 151 ؎ 54 ml/100 g of tissue per minute as compared to a baseline of 513 ؎ 76 ml/100 g/min. In the patients, a substantial difference in the cortical perfusion of more than

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“…The interobserver reproducibility of density score was analyzed using a generalized statistic. 12 The average density score of the 6 radiologists was categorized (Յ1.50 as lucent, 1.51-2.50 as intermediate and Ͼ2.50 as dense) and used in further analysis.…”

Section: Assessment Of Breast Density and Data Regarding Use Of Hrtmentioning

confidence: 99%

Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT

et al. 2001

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Key words: mammography screening; interval cancer; breast density; HRTAs a result of the mortality reduction found in several randomized controlled clinical trials, 1,2 breast cancer screening programs have been implemented in several western countries. 3 The Norwegian Breast Cancer Screening Program is a population-based program that offers women aged 50 -69 years biannual mammography screening. The program started as a pilot project in 4 counties in 1996, and the results from the first screening round were reported earlier. 4 Interval cancers can be defined as breast cancer diagnosed in screened women during the interval between 2 screening rounds, where the diagnosis does not follow from the screening examination. 5 The benefit of attending a screening program is reduced for women diagnosed with interval cancer. Thus the effect of a screening program in terms of mortality reduction can diminish if the frequency of interval cancer is high. This frequency depends, among other factors, on sensitivity of the test and length of the screening interval.Most interval cancers are diagnosed because of symptoms, hence interval and screening-detected cancers might be expected to have different characteristics. High breast density and use of hormone replacement therapy (HRT) have been discussed as possible contributors to reduction of screening sensitivity, and this may be related to occurrence of interval cancers. 6 -11 The purpose of our study was to quantify the interval cancers in the pilot project and to explore characteristics and factors that may be associated with interval cancer. To study the relations between use of HRT, breast density and interval cancer, data from a blinded review (breast density) and a questionnaire (use of HRT) were linked. MATERIAL AND METHODS Screening populationThe Norwegian Breast Cancer Screening Program is population based and covers women aged 50 -69 years. The screening population is identified through the Central Population Register, in which each inhabitant in Norway has a unique 11-digit number. Women are invited into the Norwegian Breast Cancer Screening Program irrespective of previous breast cancer history. The screening interval is 2 years. Two-view mammograms and independent double reading are standard. The pilot project included 4 counties with about 40% of the Norwegian female population aged 50 -69 years. During the first round (1996-97), 159,887 women born from 1927-46 were invited and 127,064 women were examined (79.5%). 4 Study subjectsWomen who had their first screening examination within the pilot project after July 31, 1998 (n ϭ 411) and women who experienced recurrence in the same breast as a previous lesion (n ϭ 6) were excluded from the study. Women who received a cancer diagnosis in the first screening round (n ϭ 854) were not included as being at risk of interval cancer. However, women who were screen-positive but cleared after assessment were included. This left 125,793 women at risk of developing interval cancer. The women were followed until the date an in...

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Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic

Cited by 411 publications

References 16 publications

Vascular grading of angiogenesis: prognostic significance in breast cancer

Vascular grading of angiogenesis: prognostic significance in breast cancer

Quantification of renal perfusion abnormalities using an intravascular contrast agent (part 2): Results in animals and humans with renal artery stenosis

Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT

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